Definitive Management of Primary Bladder Tumors in the Context of Metastatic Disease: Who, How, When, and Why?
Definitive Management of Primary Bladder Tumors in the Context of Metastatic Disease: Who, How, When, and Why?
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DOI：
10.1200/jco.2016.68.3714
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发表时间：
2016-10-10
影响因子：
45.3
通讯作者：
Ferket, Bart S.
中科院分区：
文献类型：
--
作者：
Galsky, Matthew D.;Domingo-Domenech, Josep;Ferket, Bart S.
肿瘤学大圆桌会议系列旨在将期刊上发表的原始报告纳入临床背景。病例介绍之后是诊断和管理挑战的描述，相关文献的回顾，以及作者建议的管理方法的总结。本系列的目的是帮助读者更好地了解如何将关键研究的结果应用于他们自己的临床实践中的患者，包括发表在《临床肿瘤学杂志》上的研究结果。一名70岁的男性膀胱尿路上皮癌（UBC）转移到盆腔和腹膜后淋巴结，接受吉西他滨联合顺铂治疗，但两个周期后出现了贫血性脓毒症，需要长期入住重症监护室恢复后，重复成像研究显示进行性盆腔和腹膜后淋巴结病，患者参加了一项临床试验，评估了抗PD-L1抗体治疗。患者对免疫检查点阻断实现了完全放射学应答，在开始治疗后持续了18个月（图1）。然而，在那个时候，膀胱镜检查他的原发性肿瘤和经尿道切除术显示残留的肌肉浸润性UBC。患者询问根治性化疗或放疗对其原发性膀胱肿瘤的确定性局部治疗是否有任何作用。
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 70-year-old man with urothelial cancer of the bladder (UBC) metastatic to the pelvic and retroperitoneal lymph nodes was treated with gemcitabine plus cisplatin, but after two cycles neutropenic sepsis developed, which required a prolonged intensive care unit admission. Upon recovery, repeat imaging studies revealed progressive pelvic and retroperitoneal lymphadenopathy, and the patient enrolled in a clinical trial that evaluated treatment with an anti-PD-L1 antibody. The patient achieved a complete radiographic response to immune checkpoint blockade, which continued for 18 months after initiating therapy (Fig 1). However, at that time, a cystoscopy of his primary tumor and a transurethral resection revealed residual muscle-invasive UBC. The patient asked whether there is any role for definitive local therapy of his primary bladder tumor with radical cystectomy or radiation.