© 2004 Foundation for Promotion of Cancer Research
Treatment of Invasive Bladder Cancer: Lessons from the Past and Perspective for the Future
Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
Radical cystectomy with lymphadenectomy is the gold standard for treatment of invasive bladder cancer. However, the treatment alone does not always provide a satisfactory result for the disease extending outside the bladder. In this review we discuss several clinical issues in the diagnosis and treatment of this invasive disease. Although the quality of diagnostic imaging modalities has improved, they are still not sensitive enough for the staging of the disease, especially for early invasive disease. In addition, lack of serum markers hinders appropriate monitoring of patients with the disease. Regarding the surgical aspect of lymphadenectomy, the area of its dissection, the standard number of nodes retrieved and the method of pathological examination should be established so that the clinical benefits of surgery can be more clearly defined. Neoadjuvant chemotherapy for invasive disease is promising for improvement of survival of patients. A chemotherapy regimen as effective as, but less toxic than, MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) has been reported and several phase III clinical trials have been launched to determine the benefits of adjuvant or neoadjuvant chemotherapy with newly developed agents. However, we still lack a chemotherapy regimen more effective than MVAC, which is the most crucial issue in the treatment of this invasive disease. An alternative option for such disease may be bladder preservation with transurethral resection of tumor followed by chemoradiotherapy. However, patients who are indicated for this treatment may be limited to those with early invasive disease having certain favorable clinical and pathological features.
+ For reprints and all correspondence: Taiji Tsukamoto, Department of Urology, Sapporo Medical University School of Medicine, Minami 1-Jo, Nishi 16-chome, Chuo-Ku, Sapporo 060-8543, Japan. E-mail: taijit{at}sapmed.ac.jp
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. Miyanaga, H. Akaza, S. Hinotsu, A. Joraku, T. Oikawa, N. Sekido, K. Kawai, and T. Shimazui Background Variables for the Patients with Invasive Bladder Cancer Suitable for Bladder-preserving Therapy Jpn. J. Clin. Oncol., November 1, 2007; 37(11): 852 - 857. [Abstract] [Full Text] [PDF]
|
|