Treatment of muscle-invasive and metastatic bladder cancer – update of the EAU Guidelines
Authors:
A. Stenzl 1; N. C. Cowan 2; M. De Santis 3; M. A. Kuczyk 4; A. S. Merseburger 4; M. J. Ribal 5; A. Sherif 6; J. A. Witjes 7
Authors place of work:
Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 7 07 Tuebingen, Germany
1; Department of Radiology, The Churchill Hospital, Oxford, United Kingdom
2; 3rd Medical Department and ACR-ITR/CEADDP and LBI-ACR Vienna-CTO, Kaiser Franz Josef Spital, Vienna, Austria
3; Department of Urology and Urologic Oncology, Hannover Medical School (MHH), Hannover, Germany
4; Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
5; Department of Urology, Karolinska University Hospital, Stockholm, Sweden
6; Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
7
Published in the journal:
Urol List 2011; 9(3): 75-86
Summary
Context:
New data regarding treatment of muscle-invasive and metastatic bladder cancer (MiM-BC) has emerged and led to an update of the European Association of Urology (EAU) guidelines for MiM-BC.
Objective:
To review the new EAU guidelines for MiM-BC with a specific focus on treatment.
Evidence acquisition:
New literature published since the last update of the EAU Guidelines in 2008 was obtained from Medline, the Cochrane Database of Systematic Reviews, and reference lists in publications and review articles and comprehensively screened by a group of urologists, oncologists, and a radiologist appointed by the EAU Guidelines Office. Previous recommendations based on the older literature on this subject were also taken into account. Levels of evidence (LEs) and grades of recommendations (GRs) were added based on a system modified from the Oxford Centre for Evidence-based Medicine Levels of Evidence.
Evidence synthesis:
Current data demonstrate that neoadjuvant chemotherapy in conjunction with radical cystectomy (RC) is recommended in certain constellations of MiM-BC. RC remains the basic treatment of choice in localised invasive disease for both sexes. An attempt has been made to define the extent of surgery under standard conditions in both sexes. An orthotopic bladder substitute should be offered to both male and female patients lacking any contraindications, such as no tumour at the level of urethral dissection. In contrast to neoadjuvant chemotherapy, current advice recommends the use of adjuvant chemotherapy only within clinical trials. Multimodality bladder-preserving treatment in localised disease is currently regarded only as an alternative in selected, well-informed, and compliant patients for whom cystectomyis not considered formedical or personal reasons. Inmetastatic disease, the first-line treatment for patients fit enough to sustain cisplatin remains cisplatin-containing combination chemotherapy. With the advent of vinflunine, second-line chemotherapy has become available.
Conclusions:
In the treatment of localised invasive bladder cancer (BCa), the standard treatment remains radical surgical removal of the bladder within standard limits, including as-yet-unspecified regional lymph nodes. However, the addition of neoadjuvant chemotherapy must be considered for certain specific patient groups. A new drug for second-line chemotherapy (vinflunine) in metastatic disease has been approved and is recommended.
Key words:
bladder cancer, muscle-invasive, chemotherapy, radiation therapy, cystectomy, EAU Guidelines, multidisciplinary management, quality of life
Zdroje
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Štítky
Paediatric urologist UrologyČlánok vyšiel v časopise
Urological Journal
2011 Číslo 3
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