Scholarlink

<p>Radical cystectomy (RC) with pelvic lymph node dissection and perioperative systemic therapy remains the standard treatment for muscle-invasive bladder cancer. However, owing to its substantial morbidity, impact on quality of life, and functional consequences, bladder-preserving treatment strategies have gained increasing attention. Trimodal therapy (TMT) consisting of maximal transurethral resection of the bladder tumor (TURB) and combined radiochemotherapy is an established guideline-recommended alternative to RC for carefully selected patients. Long-term data demonstrate disease-specific and metastasis-free survival outcomes comparable to those achieved with cystectomy, while preserving a&#xa0;functional bladder in the majority of long-term survivors. Concurrent chemotherapy improves local control and overall survival. Moderately hypofractionated radiotherapy (55 Gy in 20&#xa0;fractions) has become the current standard, and modern adaptive radiotherapy techniques further reduce treatment-related toxicity. In parallel, bladder preservation following systemic therapy alone is being actively investigated. This approach is supported by the high complete response rates achieved with contemporary perioperative treatment regimens. Phase&#xa0;II trials, including RETAIN‑1, RETAIN‑2, and HCRN GU16-257, suggest that selected patients achieving a&#xa0;clinical complete response (cCR) can remain metastasis free under active surveillance while maintaining long-term bladder preservation. However, assessment of cCR and patient selection remain imperfect, and the risk of understaging continues to represent a&#xa0;major limitation. While TMT is already an established curative bladder-preserving treatment option, omission of both cystectomy and radiotherapy after systemic therapy alone should be considered investigational. Future progress will likely depend on improved patient selection through molecular biomarkers, circulating tumor DNA (ctDNA), advanced imaging modalities, and standardized response assessment criteria.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Blasenerhaltende Therapie beim muskelinvasiven Urothelkarzinom: aktuelle Konzepte und neue Entwicklungen

  • 期刊论文

  • 发表日期：

    2026年7月30日

查看全文
  • Tobias Hölscher,
  • Camilla Grunewald,
  • Günter Niegisch

摘要

Radical cystectomy (RC) with pelvic lymph node dissection and perioperative systemic therapy remains the standard treatment for muscle-invasive bladder cancer. However, owing to its substantial morbidity, impact on quality of life, and functional consequences, bladder-preserving treatment strategies have gained increasing attention. Trimodal therapy (TMT) consisting of maximal transurethral resection of the bladder tumor (TURB) and combined radiochemotherapy is an established guideline-recommended alternative to RC for carefully selected patients. Long-term data demonstrate disease-specific and metastasis-free survival outcomes comparable to those achieved with cystectomy, while preserving a functional bladder in the majority of long-term survivors. Concurrent chemotherapy improves local control and overall survival. Moderately hypofractionated radiotherapy (55 Gy in 20 fractions) has become the current standard, and modern adaptive radiotherapy techniques further reduce treatment-related toxicity. In parallel, bladder preservation following systemic therapy alone is being actively investigated. This approach is supported by the high complete response rates achieved with contemporary perioperative treatment regimens. Phase II trials, including RETAIN‑1, RETAIN‑2, and HCRN GU16-257, suggest that selected patients achieving a clinical complete response (cCR) can remain metastasis free under active surveillance while maintaining long-term bladder preservation. However, assessment of cCR and patient selection remain imperfect, and the risk of understaging continues to represent a major limitation. While TMT is already an established curative bladder-preserving treatment option, omission of both cystectomy and radiotherapy after systemic therapy alone should be considered investigational. Future progress will likely depend on improved patient selection through molecular biomarkers, circulating tumor DNA (ctDNA), advanced imaging modalities, and standardized response assessment criteria.