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Ces Urol 2016; 20(4): 309–316
ORIGINÁLNÍ PRÁCE
nemal za sledované obdobie žiadny pacient, jeden
pacient (8%) mal po dvoch rokoch chirurgicky od‑
stránené obturátorové LU (potvrdené metastázy),
3(21%) pacienti mali recidívu neinvazívneho high‑
-grade urotelového karcinómu pT1,G3. 13(92%)
pacienti prežívajú 1–11 rokov (medián 6 rokov),
žiadny pacient neexitoval na progresiu ochorenia,
1(8%) pacient exitoval na akútny IM.
Záver:
Z našej limitovanej štúdie vyplýva, že
u dobre selektovaných pacientov s infiltratívnymi
urotelovými nádormi močového mechúra (pT0
po re-TURB) môžeme po trimodálnej liečbe do‑
siahnuť kompletnú remisiu ochorenia s minimál‑
nym rizikom lokálnej ako aj systémovej progresie
a dlhodobým beznádorovým prežívaním. Pri tejto
liečebnej stratégii je nevyhnutná multidisciplinár‑
na spolupráca urológov, radiačných onkológov
a klinických onkológov ako aj úzka spolupráca od
pacientov, ktorí vyžadujú dlhoročné pravidelné
cystoskopické ako aj CT/MR kontroly pre riziko lo‑
kálnej alebo systémovej recidívy.
KĽÚČOVÉ SLOVÁ
Infiltratívne nádory močového mechúra, TURB,
chemorádioterapia, trimodálna liečba, zachovanie
močového mechúra.
SUMMARY
Eliáš B, Tomaškin R, Kliment J ml., Šulgan J, Kli‑
ment J. Bladder sparing treatment for muscle- in‑
vasive bladder cancers.
Objectives:
The aim of this study was to
evaluate treatment outcomes of muscle-invasive
bladder cancers treated with radical TURB fol‑
lowed by adjuvant chemotherapy, radiotherapy,
or their combination in order to preserve func‑
tional bladder.
Material and methods:
We retrospectively
evaluated patients with muscle-invasive urothelial
tumors who were treated at the Department of
Urology in Martin from 2005–2016 by radical TURB
followed by adjuvant therapy. If histological ex‑
amination confirmed invasive urothelial carcinoma
(pT2a-pT2b) all such patients underwent re-TURB. In
the analysis were included only patients who had
negative histology (pT0) after re-TURB, the primary
solitary tumor was ≤3 cm in size, ureterohydrone‑
phrosis was not present, not the presence of dif‑
fuse CIS and there was no tumor invaded outside
the bladder wall. Thereafter, patients were treated
with adjuvant chemotherapy, radiotherapy or their
combination. Statistically, we evaluated baseline
characteristics of the patients, adjuvant therapy,
recurrence rate and overall survival.
Results:
The cohort of 14 patients aged 54–69
years (mean 61 years) consisted of 7 women and
7 men. All of the patients after radical TUR-B had
confirmed invasive urothelial carcinoma pT2a-pT2b,
G2-G3 After re-TURB no patient had residual tumor
from the base (pT0), one patient had CT verified
enlargement of obturator LN up to 3 cm. Adjuvant
chemotherapy as a monotherapy underwent 6
(42%) patients, 7 (50%) underwent concomitant
chemoradiotherapy and 1 (8%) patient refused
any treatment. Local recurrence of muscle-invasive
bladder tumor was not present in none of the
patients, 1 (8%) patient surgically removed obtu‑
rator LN (confirmed metastasis) after two years, 3
(21%) patients had a recurrence of a non-invasive
high-grade urothelial carcinoma pT1, G3. 13 (92%)
patients are surviving 1–11 years (median 6 years),
no patient has died because of disease progression,
1 (8%) patient died due to MI.
Conclusion:
The results of our limited study
suggest, that in well- selected patients with muscle
invasive transitional cell bladder cancers (pT0 after
re-TURB) after trimodal therapy we can achieve
complete response with minimal risk of local or
systemic progression and long-term cancer spe‑
cific-free survival. It requires multidisciplinary col‑
laboration of urologist, radiation oncologist and
medical oncologist as well as close cooperation of
patients who require regular long-term cystoscopic
and CT / MR surveillance because of a risk of local
or systemic recurrence.
KEY WORDS
Muscle-invasive bladder cancers, TURB, chemora‑
diotherapy, trimodality therapy, bladder sparing,
bladder preservation.
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