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🌱 來自: bladder cancer

management of muscle invasive disease

• Radical cystectomy is tx of choice for muscle invasive dz w/ urinary diversion
• Neoadjuvant cisplatin-based chemo prior to cystectomy improves OS (NEJM 2003;349:859; Lancet 2003;361:1927).
  • Regimens include
    • dose-dense (dd)MVAC methotrexate,
    • vinblastine,
    • doxorubicin,
    • cisplatin (JCO 2014;32:1895; JCO 2014;32:1889) or GC-gemcitabine,
    • cisplatin (Clin Genitourin Cancer 2020;18:387)
• Bladder preservation options include trimodality tx:
  • TURBT, followed by concurrent chemoradiation (NEJM 2012;366:1477).
  • Pt selection key,
    • w/ up to 40% requiring cystectomy for tx failure or dz recurrence.
    • Criteria:
      • Eligibility for complete TURBT,
      • adequate bladder fxn,
      • UC histology,
      • early stage (T2),
      • no multifocal dz & no hydronephrosis
• No completed prospective RCT establishes adjuvant chemo after radical cystectomy,
  • though meta-analyses show survival benefit (Eur Urol 2014;66:42)
• Emerging data in high-risk pts shows ↑ disease free survival (DFS) w/ adjuvant nivolumab (N Engl J Med 2021;384:2102)