Spregledana korist neoadjuvantne kemoterapije v zdravljenju mišično invazivnega raka sečnega mehurja An overlooked benefit of neoadjuvant chemotherapy in the treatment of muscle-invasive cancer of the urinary bladder

Abstract

Rak sečnega mehurja predstavlja tretji najpogostejši malignom genitourinarnega trakta, incidenca in umrljivost za rakom sečnega mehurja pa sta v Sloveniji v porastu. V radikalnem zdravljenju mišično invazivnega raka sečnega mehurja je ključnega pomena lokoregionalno zdravljenje, bolniki pa so lahko deležni tudi dodatnih koristi od sistemskega zdravljenja s kemoterapijo. Klinične raziskave faze III so pokazale pomembno podaljšanje skupnega preživetja bolnikov, ki so bili zdravljeni s kombinirano neoadjuvantno kemoterapijo na osnovi cisplatina. Kljub njeni jasno dokazani učinkovitosti se neoadjuvantna kemoterapija v vsakodnevni klinični praksi širom po svetu ni uveljavila v zadostni meri. Vsak bolnik z mišično invazivnim rakom sečnega mehurja, ki je zdravljen z namenom ozdravitve in je kandidat za sistemsko zdravljenje, bi moral biti seznanjen z možnostjo zdravljenja z neoadjuvantno kemoterapijo.

Abstract (Eng)

Urinary bladder cancer is the third most frequent malignancy of the genitourinary tract, and its incidence and mortality have been increasing in Slovenia. Loco-regional treatment is key in radical treatment of the muscle-invasive cancer of the urinary bladder, and systemic chemotherapy treatment may provide additional benefits to the patients. Phase III clinical trials have demonstrated a significant prolongation of the overall survival of patients treated with neoadjuvant cisplatin-based combination chemotherapy. However, neoadjuvant chemotherapy has not yet been established sufficiently in everyday clinical practice, despite its clearly demonstrated effectiveness. Every patient with muscle-invasive cancer of the urinary bladder, who is receiving treatment with a curative intent and is a candidate for systemic treatment, should be informed of the possibility of receiving neoadjuvant chemotherapy treatment.