Raadpleeg ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij blaaskanker van arts-bioloog drs. Engelbert Valstar

29 juli 2019: Bron: The Oncologist Published online before print July 10, 2019.

Wanneer patienten met blaaskanker naast bestraling of naast chemo plus bestraling 5 behandelingen krijgen met zogeheten diepte hyperthermie van het bekkengebied en daarna een TURP operatie dan verhoogt dat de kansen op een complete response - klinisch kankervrij aanzienlijk. Ook de 5-jaars overall overleving steeg met tientallen procenten in vergelijking zonder hyperthermie.

Hyperthermie aanvullend op alleen bestraling zorgde voor een overall overleving (OS) van 45 vs 87 procent en in vergelijking met chemo plus bestraling was de overall overleving 64 vs 87 procent. En een betere kwalliteit van leven.

Dit blijkt uit een gerandomiseerde studie bij totaal 369 blaaskankerpatienten met pTa, pTis, pT1, en pT2 cN0–1 cM0

De studie betrof drie groepen, 215 patienten kregen chemo plus radiotherapie, 79 patienten kregen alleen bestraling en 79 patienten kregen aanvullend hyperthermie. Over een lange periode van bijna 30 jaar, van 1982 tot 2016.

Voor het volledige studierapport: Long‐Term Experience of Chemoradiotherapy Combined with Deep Regional Hyperthermia for Organ Preservation in High‐Risk Bladder Cancer (Ta, Tis, T1, T2) moet worden betaald:

Hier het abstract van de studie:

Long‐Term Experience of Chemoradiotherapy Combined with Deep Regional Hyperthermia for Organ Preservation in High‐Risk Bladder Cancer (Ta, Tis, T1, T2)

+Author Affiliations

a Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
b Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen, Erlangen, Germany
c Department of Urology, Martha Maria Medical Center, Nuremberg, Germany
d Department of Radiotherapy and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
e Department of Radiation Oncology, Klinikum Darmstadt GmbH, Darmstadt, Germany
f Department of Medical Informatics, Biometry and Epidemiology, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany
g Friedrich‐Alexander‐Universität Erlangen‐Nürnberg, Erlangen, Germany

↵*Correspondence: Ricarda Merten, Dr. med., Department of Radiation Oncology, Universitätsklinikum Erlangen, Universitätsstraße 27, D‐91054 Erlangen, Germany. Telephone: 49 9131 8544246; e‐mail: ricarda.merten@uk-erlangen.de

↵† Contributed equally.

Received May 9, 2018.
Accepted February 11, 2019.
Published online before print July 10, 2019.

Disclosures of potential conflicts of interest may be found at the end of this article.

Abstract

Background.

The aim of this study was to evaluate the efficacy and safety of chemoradiotherapy (RCT) combined with regional deep hyperthermia (RHT) of high‐risk bladder cancer after transurethral resection of bladder tumor (TUR‐BT).

Materials and methods.

Between 1982 and 2016, 369 patients with pTa, pTis, pT1, and pT2 cN0–1 cM0 bladder cancer were treated with a multimodal treatment after TUR‐BT. All patients received radiotherapy (RT) of the bladder and regional lymph nodes. RCT was administered to 215 patients, RCT + RHT was administered to 79 patients, and RT was used in 75 patients. Treatment response was evaluated 4–6 weeks after treatment with TUR‐BT.

Results.

Complete response (CR) overall was 83% (290/351), and in treatment groups was RT 68% (45/66), RCT 86% (178/208), and RCT + RHT 87% (67/77). CR was significantly improved by concurrent RCT compared with RT (odds ratio , 2.32; 95% confidence interval , 1.05–5.12; p = .037), less influenced by hyperthermia (OR, 2.56; 95% CI, 0.88–8.00; p = .092). Overall survival (OS) after RCT was superior to RT (hazard ratio , 0.7; 95% CI, 0.50–0.99; p = .045). Five‐year OS from unadjusted Kaplan‐Meier estimates was RCT 64% versus RT 45%. Additional RHT increased 5‐year OS to 87% (HR, 0.32; 95% CI, 0.18–0.58; p = .0001). RCT + RHT compared with RCT showed a significantly better bladder‐preservation rate (HR, 0.13; 95% CI, 0.03–0.56; p = .006). Median follow‐up was 71 months. The median number of RHT sessions was five.

Conclusion.

The multimodal treatment consisted of a maximal TUR‐BT followed by RT; concomitant platinum‐based chemotherapy combined with RHT in patients with high‐grade bladder cancer improves local control, bladder‐preservation rate, and OS. It offers a promising alternative to surgical therapies like radical cystectomy.

Implications for Practice.

Radical cystectomy with appropriate lymph node dissection has long represented the standard of care for muscle‐invasive bladder cancer in medically fit patients, despite many centers reporting excellent long‐term results for bladder preserving strategies. This retrospective analysis compares different therapeutic modalities in bladder‐preservation therapy. The results of this study show that multimodal treatment consisting of maximal transurethral resection of bladder tumor followed by radiotherapy, concomitant platinum‐based chemotherapy combined with regional deep hyperthermia in patients with Ta, Tis, T1–2 bladder carcinomas improves local control, bladder‐preservation rate, and survival. More importantly, these findings offer a promising alternative to surgical therapies like radical cystectomy. The authors hope that, in the future, closer collaboration between urologists and radiotherapists will further improve treatments and therapies for the benefit of patients.

blaaskanker, chemo plus bestraling, radiotherapie, Turp operatie, overall overleving, kwaliteit van leven