Peri-operative chemotherapy for muscle-invasive bladder cancer: status-quo in 2017.
Peri-operative chemotherapy for muscle-invasive bladder cancer: status-quo in 2017.
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DOI：
10.21037/tau.2017.09.12
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发表时间：
2017-12
影响因子：
2
通讯作者：
Seisen T
中科院分区：
文献类型：
--
作者：
Pradère B;Thibault C;Vetterlein MW;Leow JJ;Peyronnet B;Rouprêt M;Seisen T
在过去的几十年里，几项具有里程碑意义的随机对照试验（RCT）分析了围手术期化疗与根治性化疗（RC）对肌层浸润性膀胱癌的作用。关于新辅助化疗（NAC），最大RCT的1级证据和长期结果的荟萃分析支持其使用，这是目前全球大多数临床指南倡导的标准治疗。然而，关于辅助化疗（AC）的交付，证据更具争议性。具体而言，几项荟萃分析显示了与使用顺铂为基础的方案相关的生存获益，但研究者在大多数纳入的RCT中发现了多种方法学局限性。尽管如此，AC目前被认为是在RC具有不良病理特征的合适患者。值得注意的是，即使在先前接受NAC的那些患者中，手术后递送这种细胞毒性治疗也可以保持显著的抗肿瘤活性。最后，考虑到其更高的缓解率，甲氨蝶呤、长春碱、阿霉素加顺铂组合仍然优先考虑用于新辅助治疗，而吉西他滨加顺铂组合由于其更好的毒性特征而更常用于辅助治疗。然而，目前尚无前瞻性证据比较两种方案对NAC或AC的疗效。
The role of perioperative chemotherapy associated with radical cystectomy (RC) for muscle-invasive bladder cancer has been analyzed in several landmark randomized controlled trials (RCTs) over the past decades. With regard to neoadjuvant chemotherapy (NAC), a meta-analysis of level 1 evidence and long-term results from the largest RCTs support its use, which is currently advocated as the standard of care by most of the clinical guidelines worldwide. However, with regard to the delivery of adjuvant chemotherapy (AC), evidence is more contentious. Specifically, several meta-analyses demonstrated a survival benefit associated with the use of cisplatin-based regimen but investigators identified multiple methodological limitations in most of included RCTs. Nonetheless, AC is currently considered for fit patients with adverse pathological features at RC. It is noteworthy that the delivery of such cytotoxic treatment after surgery may maintain significant anti-tumor activity even in those patients who previously received NAC. Finally, given its greater response rate, the methotrexate, vinblastine, adriamycin plus cisplatin combination remains preferentially considered in the neoadjuvant setting, while the gemcitabine plus cisplatin combination is more commonly delivered in the adjuvant setting because of its better toxicity profile. However, no prospective evidence comparing efficacy of both regimens for NAC or AC is currently available.
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影响因子：
50.5
作者：
Booth, C. M.;Siemens, D. R.;Mackillop, W. J.
通讯作者：
Mackillop, W. J.
影响因子：
6.6
作者：
Culp, Stephen H.;Dickstein, Rian J.;Grossman, H. Barton;Pretzsch, Shanna M.;Porten, Sima;Daneshmand, Siamak;Cai, Jie;Groshen, Susan;Siefker-Radtke, Arlene;Millikan, Randall E.;Czerniak, Bogdan;Navai, Neema;Wszolek, Matthew F.;Kamat, Ashish M.;Dinney, Colin P. N.
通讯作者：
Dinney, Colin P. N.
DOI：
10.3233/blc-150032
发表时间：
2016-04-27
期刊：
Bladder cancer (Amsterdam, Netherlands)
影响因子：
--
作者：
Boström PJ;Mirtti T;van Rhijn B;Fleshner NE;Finelli A;Laato M;Jewett MA;Moore MJ;Sridhar S;Nurmi M;Tannock IF;Zlotta AR
通讯作者：
Zlotta AR
影响因子：
6.6
作者：
Freiha, F;Reese, J;Torti, FM
通讯作者：
Torti, FM
影响因子：
158.5
作者：
Grossman, HB;Natale, RB;Crawford, ED
通讯作者：
Crawford, ED