Metastatik Mesane Kanserine Yaklaşım
Özet
Bu çalışma, metastatik mesane kanserine yönelik klinik yaklaşımları, epidemiyoloji, etiyoloji, patoloji, evreleme ve tedavi yöntemleri kapsamında incelemektedir. Erkeklerde daha sık görülen mesane kanserinde, kasa invaziv olguların radikal sistektomi sonrası nüks etme oranı yüksek olup, hastaların %10-15'i tanı anında metastatiktir. Tütün kullanımı en önemli risk faktörüyken, patolojik olarak vakaların neredeyse tamamı yüksek dereceli ürotelyal karsinomdur. Metastatik hastalığın yönetiminde birinci basamak standart tedavi, uygun hastalarda sisplatin bazlı kombinasyon kemoterapileridir (GC veya MVAC). Ancak hastaların yarısından fazlası sisplatin için uygun olmadığından karboplatin bazlı rejimler tercih edilir. İkinci basamak tedavilerde kanıt düzeyi en yüksek onaylı seçenek vinflunindir. Kemik metastazlarında zoledronik asit ve denosumab gibi iskelet olaylarını azaltan tedaviler önerilirken, çene osteonekrozu gibi yan etkilere karşı kalsiyum ve D vitamini takviyesi şarttır. Cerrahi müdahalenin rolü sınırlı olsa da, kemoterapiye iyi yanıt veren seçilmiş vakalarda sağkalıma katkı sağlayabilir. Tedavi sonrası takip planlaması; lokal veya uzak nükslerin (en sık akciğer, karaciğer, kemik) tespiti ile üriner diversiyona bağlı metabolik asidoz, böbrek fonksiyon bozukluğu ve kırık riski gibi uzun vadeli fonksiyonel komplikasyonların izlenmesini içerir.
This study examines clinical approaches to metastatic bladder cancer within the scope of epidemiology, etiology, pathology, staging, and treatment methods. Bladder cancer, which is more common in men, has a high recurrence rate after radical cystectomy in muscle-invasive cases, and 10-15% of patients are metastatic at the time of diagnosis. While tobacco use is the most significant risk factor, pathologically almost all cases are high-grade urothelial carcinomas. In the management of metastatic disease, the first-line standard treatment for eligible patients is cisplatin-based combination chemotherapies (GC or MVAC). However, since more than half of the patients are unfit for cisplatin, carboplatin-based regimens are preferred. In second-line treatments, vinflunine is the approved option with the highest level of evidence. For bone metastases, bone-targeted therapies such as zoledronic acid and denosumab that reduce skeletal events are recommended, while calcium and vitamin D supplementation is essential against side effects like osteonecrosis of the jaw. Although the role of surgical intervention remains limited, it may contribute to survival in selected cases with a good response to chemotherapy. Post-treatment follow-up planning includes the detection of local or distant recurrences (most commonly in lymph nodes, lungs, liver, and bone) and the monitoring of long-term functional complications due to urinary diversion, such as metabolic acidosis, worsening of renal function, and increased fracture risk.
Referanslar
Burger, M., et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol, 2013. 63: 234. https://www.ncbi.nlm.nih.gov/pubmed/22877502
Bosetti, C., et al. Trends in mortality from urologic cancers in Europe, 1970-2008. Eur Urol, 2011. 60: 1.
Steinmaus, C., et al. Increased lung and bladder cancer incidence in adults after in utero and earlylife arsenic exposure. Cancer Epidemiol Biomarkers Prev, 2014. 23: 1529.
Skinner, D.G., et al. Adjuvant chemotherapy following cystectomy benefits patients with deeply invasive bladder cancer. Semin Urol, 1990. 8: 279.
Freedman, N.D., et al. Association between smoking and risk of bladder cancer among men and women. JAMA, 2011. 306: 737.
Pashos, C.L., et al. Bladder cancer: epidemiology, diagnosis, and management. Cancer Pract, 2002. 10: 311. https://www.ncbi.nlm.nih.gov/pubmed/12406054
Chrouser, K., et al. Bladder cancer risk following primary and adjuvant external beam radiation for prostate cancer. J Urol, 2005. 174: 107.
Zamora-Ros, R., et al. Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Br J Cancer, 2014. https://www.ncbi.nlm.nih.gov/pubmed/25121955
Schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994. IARC Monogr Eval Carcinog Risks Hum, 1994. 61: 1. https://www.ncbi.nlm.nih.gov/pubmed/771506
Liu, S., et al. The impact of female gender on bladder cancer-specific death risk after radical cystectomy: a meta-analysis of 27,912 patients. Int Urol Nephrol, 2015. 47: 951. https://www.ncbi.nlm.nih.gov/pubmed/25894962
Scosyrev, E., et al. Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer, 2009. 115: 68. https://www.ncbi.nlm.nih.gov/pubmed/19072984
Fritsche, H.M., et al. Prognostic value of perinodal lymphovascular invasion following radical cystectomy for lymph node-positive urothelial carcinoma. Eur Urol, 2013. 63: 739. https://www.ncbi.nlm.nih.gov/pubmed/23079053
Ku, J.H., et al. Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis. BMC Cancer, 2015. 15: 447. https://www.ncbi.nlm.nih.gov/pubmed/26027955
Jimenez, R.E., et al. Grading the invasive component of urothelial carcinoma of the bladder and its relationship with progression-free survival. Am J Surg Pathol, 2000. 24: 980. https://www.ncbi.nlm.nih.gov/pubmed/10895820
Sjodahl, G., et al. A molecular taxonomy for urothelial carcinoma. Clin Cancer Res, 2012. 18: 3377. https://www.ncbi.nlm.nih.gov/pubmed/22553347
Choi, W., et al. Identification of distinct basal and luminal subtypes of muscle-invasive bladder cancer with different sensitivities to frontline chemotherapy. Cancer Cell, 2014. 25: 152. https://www.ncbi.nlm.nih.gov/pubmed/24525232
WHO Classification of Tumours of the Urinary System and Male Genital Organs. 4th ed. 2016, Lyon, France http://publications.iarc.fr/Book-And-Report-Series/Who-Iarc-Classification-Of-Tumours/WhoClassification-Of-Tumours-Of-The-Urinary-System-And-Male-Genital-Organs-2016
Sauter G, et al., Tumours of the urinary system: non-invasive urothelial neoplasias., in WHO classification of classification of tumors of the urinary system and male genital organs. 2004, IARC Press: Lyon.
Bellmunt, J., et al. Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol, 2010. 28: 1850. https://www.ncbi.nlm.nih.gov/pubmed/20231682
Lehmann, J., et al. Adjuvant cisplatin plus methotrexate versus methotrexate, vinblastine, epirubicin, and cisplatin in locally advanced bladder cancer: results of a randomized, multicenter, phase III trial (AUO-AB 05/95). J Clin Oncol, 2005. 23: 4963. https://www.ncbi.nlm.nih.gov/pubmed/15939920
Carles, J., et al. Feasiblity study of gemcitabine and cisplatin administered every two weeks in patients with advanced urothelial tumors and impaired renal function. Clin Transl Oncol, 2006. 8: 755. https://www.ncbi.nlm.nih.gov/pubmed/17074675
Hussain, S.A., et al. A phase I/II study of gemcitabine and fractionated cisplatin in an outpatient setting using a 21-day schedule in patients with advanced and metastatic bladder cancer. Br J Cancer, 2004. 91: 844. https://www.ncbi.nlm.nih.gov/pubmed/15292922
Morales-Barrera, R., et al. Cisplatin and gemcitabine administered every two weeks in patients with locally advanced or metastatic urothelial carcinoma and impaired renal function. Eur J Cancer, 2012. 48: 1816. https://www.ncbi.nlm.nih.gov/pubmed/22595043
Nogue-Aliguer, M., et al. Gemcitabine and carboplatin in advanced transitional cell carcinoma of the urinary tract: an alternative therapy. Cancer, 2003. 97: 2180. https://www.ncbi.nlm.nih.gov/pubmed/12712469
Stockle, M., et al. Adjuvant polychemotherapy of nonorgan-confined bladder cancer after radical cystectomy revisited: long-term results of a controlled prospective study and further clinical experience. J Urol, 1995. 153: 47. https://www.ncbi.nlm.nih.gov/pubmed/7966789
Mayr, R., et al. Comorbidity and performance indices as predictors of cancer-independent mortality but not of cancer-specific mortality after radical cystectomy for urothelial carcinoma of the bladder. Eur Urol, 2012. 62: 662. https://www.ncbi.nlm.nih.gov/pubmed/22534059
Balducci, L., et al. Management of cancer in the older person: a practical approach. Oncologist, 2000. 5: 224. https://www.ncbi.nlm.nih.gov/pubmed/10884501
De Santis, M., et al. New developments in first- and second-line chemotherapy for transitional cell, squamous cell and adenocarcinoma of the bladder. Curr Opin Urol, 2007. 17: 363. https://www.ncbi.nlm.nih.gov/pubmed/17762632
Raj, G.V., et al. Formulas calculating creatinine clearance are inadequate for determining eligibility for Cisplatin-based chemotherapy in bladder cancer. J Clin Oncol, 2006. 24: 3095. https://www.ncbi.nlm.nih.gov/pubmed/16809735
Bellmunt, J., et al. New therapeutic challenges in advanced bladder cancer. Semin Oncol, 2012. 39: 598. https://www.ncbi.nlm.nih.gov/pubmed/23040256
Gabrilove, J.L., et al. Effect of granulocyte colony-stimulating factor on neutropenia and associated morbidity due to chemotherapy for transitional-cell carcinoma of the urothelium. N Engl J Med, 1988. 318: 1414. https://www.ncbi.nlm.nih.gov/pubmed/2452983
Meluch, A.A., et al. Paclitaxel and gemcitabine chemotherapy for advanced transitional-cell carcinoma of the urothelial tract: a phase II trial of the Minnie pearl cancer research network. J Clin Oncol, 2001. 19: 3018. https://www.ncbi.nlm.nih.gov/pubmed/11408496
Dash, A., et al. Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer, 2006. 107: 506. https://www.ncbi.nlm.nih.gov/pubmed/16773629
Galsky, M.D., et al. Treatment of patients with metastatic urothelial cancer “unfit” for Cisplatin-based chemotherapy. J Clin Oncol, 2011. 29: 2432. https://www.ncbi.nlm.nih.gov/pubmed/21555688
Parameswaran R, et al. A Hoosier Oncology Group phase II study of weekly paclitaxel and gemcitabine in advanced transitional cell (TCC) carcinoma of the bladder. Proc Am Soc Clin Oncol, 2001. 200.
Guardino AE, Gemcitabine and paclitaxel as second line chemotherapy for advanced urothelial malignancies. Proc Am Soc Clin Oncol 2002. 21.
Fechner, G., et al. Randomised phase II trial of gemcitabine and paclitaxel second-line chemotherapy in patients with transitional cell carcinoma (AUO Trial AB 20/99). Int J Clin Pract, 2006. 60: 27. https://www.ncbi.nlm.nih.gov/pubmed/16409425
Ko, Y.J., et al. Nanoparticle albumin-bound paclitaxel for second-line treatment of metastatic urothelial carcinoma: a single group, multicentre, phase 2 study. Lancet Oncol, 2013. 14: 769. https://www.ncbi.nlm.nih.gov/pubmed/23706985
Kanzaki, R., et al. Outcome of surgical resection of pulmonary metastasis from urinary tract transitional cell carcinoma. Interact Cardiovasc Thorac Surg, 2010. 11: 60. https://www.ncbi.nlm.nih.gov/pubmed/20395251
Lehmann, J., et al. Surgery for metastatic urothelial carcinoma with curative intent: the German experience (AUO AB 30/05). Eur Urol, 2009. 55: 1293. https://www.ncbi.nlm.nih.gov/pubmed/19058907
Matsuguma, H., et al. Is there a role for pulmonary metastasectomy with a curative intent in patients with metastatic urinary transitional cell carcinoma? Ann Thorac Surg, 2011. 92: 449. https://www.ncbi.nlm.nih.gov/pubmed/21801905
Otto, T., et al. Impact of surgical resection of bladder cancer metastases refractory to systemic therapy on performance score: a phase II trial. Urology, 2001. 57: 55. https://www.ncbi.nlm.nih.gov/pubmed/11164143
Sarmiento, J.M., et al. Solitary cerebral metastasis from transitional cell carcinoma after a 14-year remission of urinary bladder cancer treated with gemcitabine: Case report and literature review. Surg Neurol Int, 2012. 3: 82. https://www.ncbi.nlm.nih.gov/pubmed/22937482
Tanis, P.J., et al. Surgery for isolated lung metastasis in two patients with bladder cancer. Urology, 2005. 66: 881. https://www.ncbi.nlm.nih.gov/pubmed/16230169
Sweeney, P., et al. Is there a therapeutic role for post-chemotherapy retroperitoneal lymph node dissection in metastatic transitional cell carcinoma of the bladder? J Urol, 2003. 169: 2113. https://www.ncbi.nlm.nih.gov/pubmed/12771730
Siefker-Radtke, A.O., et al. Is there a role for surgery in the management of metastatic urothelial cancer? The M. D. Anderson experience. J Urol, 2004. 171: 145. https://www.ncbi.nlm.nih.gov/pubmed/14665863
Coleman, R.E. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev, 2001. 27: 165. https://www.ncbi.nlm.nih.gov/pubmed/11417967
Aapro, M., et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol, 2008. 19: 420. https://www.ncbi.nlm.nih.gov/pubmed/17906299
Henry, D.H., et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol, 2011. 29: 1125. https://www.ncbi.nlm.nih.gov/pubmed/21343556
Rosen, L.S., et al. Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-blind, placebo-controlled trial. Cancer, 2004. 100: 2613. https://www.ncbi.nlm.nih.gov/pubmed/15197804
Bartsch, G., et al. Urinary functional outcomes in female neobladder patients. World J Urol, 2014. 32: 221. https://www.ncbi.nlm.nih.gov/pubmed/24317553
Fokdal, L., et al. Radical radiotherapy for urinary bladder cancer: treatment outcomes. Expert Rev Anticancer Ther, 2006. 6: 269. https://www.ncbi.nlm.nih.gov/pubmed/16445379
Rodel, C., et al. Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol, 2002. 20: 3061. https://www.ncbi.nlm.nih.gov/pubmed/12118019
Lodde, M., et al. Four years experience in bladder preserving management for muscle invasive bladder cancer. Eur Urol, 2005. 47: 773. https://www.ncbi.nlm.nih.gov/pubmed/15925072
Merseburger, A.S., et al. The value of bladder-conserving strategies in muscle-invasive bladder carcinoma compared with radical surgery. Curr Opin Urol, 2007. 17: 358. https://www.ncbi.nlm.nih.gov/pubmed/17762631
Rodel, C., et al. Trimodality treatment and selective organ preservation for bladder cancer. J Clin Oncol, 2006. 24: 5536. https://www.ncbi.nlm.nih.gov/pubmed/17158539
Malkowicz, S.B., et al. Muscle-invasive urothelial carcinoma of the bladder. Urology, 2007. 69: 3. https://www.ncbi.nlm.nih.gov/pubmed/17280906
Ku, J.H., et al. Metastasis of transitional cell carcinoma to the lower abdominal wall 20 years after cystectomy. Yonsei Med J, 2005. 46: 181. https://www.ncbi.nlm.nih.gov/pubmed/15744826
Soukup, V., et al. Follow-up after surgical treatment of bladder cancer: a critical analysis of the literature. Eur Urol, 2012. 62: 290. https://www.ncbi.nlm.nih.gov/pubmed/22609313
Mathers, M.J., et al. Is there evidence for a multidisciplinary follow-up after urological cancer? An evaluation of subsequent cancers. World J Urol, 2008. 26: 251. https://www.ncbi.nlm.nih.gov/pubmed/18421461
Ware, J.E. Jr., et al. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 1992. 30: 473. https://www.ncbi.nlm.nih.gov/pubmed/1593914
Huguet, J., et al. Management of urethral recurrence in patients with Studer ileal neobladder. Eur Urol, 2003. 43: 495. https://www.ncbi.nlm.nih.gov/pubmed/12705993
