Skip to main content
SpringerLink
Log in

Therapie des nicht-muskelinvasiven Low-grade-Harnblasenkarzinoms

Therapy of low-grade nonmuscle-invasive bladder cancer

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die nicht-muskelinvasiven Karzinome der Harnblase (NMIBC) umfassen eine sehr heterogene Gruppe von Tumoren, deren biologisches Verhalten in erster Linie vom Differenzierungsgrad abhängt. Low-grade-NMIBC zeichnen sich durch ein hohes Rezidivrisiko, jedoch ein sehr geringes Progressionsrisiko aus. Ziel von Diagnostik und Therapie ist also v. a. die sichere Visualisierung und vollständige Resektion aller Herde. Zytologie und andere Urinmarker sind v. a. aufgrund der unzureichenden Sensitivität nicht hilfreich. Eine Nachresektion ist nur in Ausnahmefällen erforderlich, der Nutzen einer Erhaltungsinstillationsprophylaxe über eine einmalige Frühinstillation hinaus ist in den meisten Fällen fraglich. Auch bei den Low-grade-NIMBC ist eine Risikostratifizierung, z. B. nach den Vorgaben von EORTC oder EAU, sinnvoll.

Abstract

Nonmuscle-invasive bladder cancer (NMIBC) comprises a very heterogeneous group of malignancies; the biological behavior of these tumors depends primarily on their grading. Low-grade NMIBC are characterized by a high propensity for recurrence but a very low risk for progression to muscle invasion or metastatic disease. Thus, the first line goal of diagnostic procedures and therapy is reliable visualization and complete resection of all foci. Cytology and other urine-based markers fail due to insufficient sensitivity. A second resection might be necessary only in selected intermediate risk cases; the positive effect of maintenance instillation protocols beyond a single postoperative instillation is questionable for the majority of patients. Risk stratification, e.g., according to the EORTC or EAU proposals, also makes sense in low grade NMIBC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Kaatsch P, Spix C, Hentschel S et al (2013) Krebs in Deutschland – Beiträge zur Gesundheitsberichterstattung des Bundes. Robert Koch Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland, Bd 9. RKI, Berlin, S 100–103

  2. Bertz J, Dahm S, Haberland J et al (2010) Verbreitungen von Krebserkrankungen in Deutschland; Entwicklung der Prävalenzen zwischen 1990 und 2010– Eine Veröffentlichung des Zentrums für Krebsregisterdaten am Robert Koch Institut. RKI, Berlin, S 108–115

  3. Eble JN, Sauter G, Epstein JI, Sesterhenn IA (2004) Pathology and genetics of tumours of the urinary system and male genital organs. 6, 91. IARC Press, Lyon

  4. Eble JN, Sauter G, Epstein JI, Sesterhenn IA (2004) Pathology and genetics of tumours of the urinary system and male genital organs. 6, 90. IARC Press, Lyon

  5. Mowatt G, Zhu S, Kilonzo M et al (2010) Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer. Health Technol Assess 14(4):1–331

    Article  CAS  Google Scholar 

  6. Bastacky S, Ibrahim S, Wilczynski SP, Murphy WM (1999) The accuracy of urinary cytology in daily practice. Cancer 87(3):118–128

    Article  CAS  PubMed  Google Scholar 

  7. Planz B, Jochims E, Deix T et al (2005) The role of urinary cytology for detection of bladder cancer. Eur J Surg Oncol 31(3):304–308

    Article  CAS  PubMed  Google Scholar 

  8. Babjuk M, Böhle A, Burger M et al (2014) EAU guideline on non muscle invasive bladder cancer. European Association of Urology, editor. EAU Guidelines, Arnheim, S 1–48

  9. Denzinger S, Burger M, Walter B et al (2007) Clinically relevant reduction in risk of recurrence of superficial bladder cancer using 5-aminolevulinic acid-induced fluorescence diagnosis: 8-year results of prospective randomized study. Urology 69(4):675–679

    Article  PubMed  Google Scholar 

  10. Fradet Y, Grossman HB, Gomella L et al (2007) A comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of carcinoma in situ in patients with bladder cancer: a phase III, multicenter study. J Urol 178(1):68–73

    Article  PubMed  Google Scholar 

  11. Geavlete B, Jecu M, Multescu R et al (2010) HAL blue-light cystoscopy in high-risk nonmuscle-invasive bladder cancer – re-TURBT recurrence rates in a prospective, randomized study. Urology 76(3):664–669

    Article  PubMed  Google Scholar 

  12. Grossman HB, Gomella L, Fradet Y et al (2007) A phase III, multicenter comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of superficial papillary lesions in patients with bladder cancer. J Urol 178(1):62–67

    Article  PubMed  Google Scholar 

  13. Jichlinski P, Guillou L, Karlsen SJ et al (2003) Hexyl aminolevulinate fluorescence cystoscopy: new diagnostic tool for photodiagnosis of superficial bladder cancer – a multicenter study. J Urol 170(1):226–229

    Article  PubMed  Google Scholar 

  14. Jocham D, Witjes F, Wagner S et al (2005) Improved detection and treatment of bladder cancer using hexaminolevulinate imaging: a prospective, phase III multicenter study. J Urol 174(3):862–866

    Article  PubMed  Google Scholar 

  15. Schmidbauer J, Witjes F, Schmeller N et al (2004) Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy. J Urol 171(1):135–138

    Article  PubMed  Google Scholar 

  16. Stenzl A, Burger M, Fradet Y et al (2010) Hexaminolevulinate guided fluorescence cystoscopy reduces recurrence in patients with nonmuscle invasive bladder cancer. J Urol 184(5):1907–1913

    Article  PubMed Central  PubMed  Google Scholar 

  17. Filbeck T, Pichlmeier U, Knuechel R et al (2002) Do patients profit from 5-aminolevulinic acid-induced fluorescence diagnosis in transurethral resection of bladder carcinoma? Urology 60(6):1025–1028

    Article  CAS  PubMed  Google Scholar 

  18. Riedl CR, Daniltchenko D, Koenig F et al (2001) Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rate in superficial bladder cancer. J Urol 165(4):1121–1123

    Article  CAS  PubMed  Google Scholar 

  19. Bryan RT, Billingham LJ, Wallace DM (2008) Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder. BJU Int 101(6):702–705

    Article  PubMed  Google Scholar 

  20. Cauberg EC, Kloen S, Visser M et al (2010) Narrow band imaging cystoscopy improves the detection of non-muscle-invasive bladder cancer. Urology 76(3):658–663

    Article  PubMed  Google Scholar 

  21. Herr HW (2010) Narrow-band imaging cystoscopy to evaluate the response to bacille Calmette-Guerin therapy: preliminary results. BJU Int 105(3):314–316

    Article  PubMed  Google Scholar 

  22. Herr HW, Donat SM (2011) Reduced bladder tumour recurrence rate associated with narrow-band imaging surveillance cystoscopy. BJU Int 107(3):396–398

    Article  PubMed  Google Scholar 

  23. Herr HW, Donat SM (2008) A comparison of white-light cystoscopy and narrow-band imaging cystoscopy to detect bladder tumour recurrences. BJU Int 102(9):1111–1114

    Article  PubMed  Google Scholar 

  24. Naselli A, Introini C, Timossi L et al (2012) A randomized prospective trial to assess the impact of transurethral resection in narrow band imaging modality on non-muscle-invasive bladder cancer recurrence. Eur Urol 61(5):908–913

    Article  PubMed  Google Scholar 

  25. Burger M, Oosterlinck W, Konety B et al (2013) ICUD-EAU International Consultation on Bladder Cancer 2012: non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol 63(1):36–44

    Article  PubMed  Google Scholar 

  26. Herr HW (2005) Restaging transurethral resection of high risk superficial bladder cancer improves the initial response to bacillus Calmette-Guerin therapy. J Urol 174(6):2134–2137

    Article  PubMed  Google Scholar 

  27. Adiyat KT, Katkoori D, Soloway CT et al (2010) „Complete transurethral resection of bladder tumor“: are the guidelines being followed? Urology 75(2):365–367

    Article  PubMed  Google Scholar 

  28. Sylvester RJ, Oosterlinck W, Meijden AP van der (2004) A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol 171(6 Pt 1):2186–2190

    Article  PubMed  Google Scholar 

  29. De Nunzio C, Carbone A, Albisinni S et al (2011) Long-term experience with early single mitomycin C instillations in patients with low-risk non-muscle-invasive bladder cancer: prospective, single-centre randomised trial. World J Urol 29(4):517–521

    Article  Google Scholar 

  30. Gudjonsson S, Adell L, Merdasa F et al (2009) Should all patients with non-muscle-invasive bladder cancer receive early intravesical chemotherapy after transurethral resection? The results of a prospective randomised multicentre study. Eur Urol 55(4):773–780

    Article  PubMed  Google Scholar 

  31. Shelley MD, Wilt TJ, Court J et al (2004) Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer: a meta-analysis of randomized trials. BJU Int 93(4):485–490

    Article  CAS  PubMed  Google Scholar 

  32. Tilki D, Burger M, Dalbagni G et al (2011) Urine markers for detection and surveillance of non-muscle-invasive bladder cancer. Eur Urol 60(3):484–492

    Article  PubMed  Google Scholar 

  33. Soloway MS (2006) Expectant treatment of small, recurrent, low-grade, noninvasive tumors of the urinary bladder. Urol Oncol 24(1):58–61

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. P.J. Olbert, C.H. Ohlmann und C. Schwentner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Prostatakarzinomzentrum im Comprehensive Cancer Center Marburg, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    P.J. Olbert

  2. Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg, Deutschland

    C.H. Ohlmann

  3. Universitätsklinik für Urologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland

    C. Schwentner

Authors
  1. P.J. Olbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C.H. Ohlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Schwentner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P.J. Olbert.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Olbert, P., Ohlmann, C. & Schwentner, C. Therapie des nicht-muskelinvasiven Low-grade-Harnblasenkarzinoms. Urologe 54, 484–490 (2015). https://doi.org/10.1007/s00120-015-3773-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-015-3773-8

Schlüsselwörter

Keywords

Search

Navigation