medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2022-5-46-53medalphabet-2591Research ArticleСтатьиТрехкомпонентное лечение мышечно-инвазивного рака мочевого пузыря: случай успешного применения у пациента с IV стадией заболеванияThree-component treatment of muscle-invasive bladder cancer: Case of successful use in patient with stage IV of diseasehttps://orcid.org/0000-0002-6057-1230МедведевС. В.MedvedevS. V.

Медведев Сергей Васильевич, к.м.н., с.н.с. отделения нейрорадиологии отдела лучевой терапии

Москва

Medvedev Sergey V., PhD Med, senior researcher at Dept of Neuroradiology, Department of Radiation Therapy

Moscow

oncologrgmu@yandex.ruhttps://orcid.org/0000-0003-3774-2879ХачатурянА. В.KhachaturianA. V.

Хачатурян Александр Владимирович, к.м.н., н.с. хирургического отделения  № 4 (онкоурологии)

Москва

Khachaturyan Alexander V., PhD Med, researcher at Surgical Dept No. 4  (Oncourology)

Moscow

centrforward@mail.ruhttps://orcid.org/0000-0003-3942-4102РомановД. С.RomanovD. S.

Романов Денис Сергеевич, к.м.н., зам. ген. директора по научной деятельности, врач-онколог, зав. радиологическим отделением, ассистент кафедры онкологии и лучевой терапии

Москва

SPIN-код: 1662–8411

Romanov Denis S., PhD Med, deputy CEO for scientific activity, oncologist, head of Dept of Radiology, assistant of Dept of Oncology and Radiation Therapy

Moscow

 SPIN code: 1662–8411

https://orcid.org/0000-0002-2159-7104ПрокопьеваВ. В.ProkopyevaV. V.

Прокопьева Виктория Викторовна, студентка VI курса лечебного факультета

Москва

Prokopyeva Victoria V., 6th year student of Faculty of Medicine

Moscow

vika.prokopieva.98@bk.ruМосковский научно-исследовательский онкологический институт имени П. А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияMoscow Research Institute n. a. P. A. Herzen – a Branch of the National Medical Research Centre of RadiologyRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Блохина» Минздрава РоссииРоссияNational Medical Research Centre of Oncology n. a. N. N. BlokhinRussian FederationООО «Центр инновационных медицинских технологий»; ЧУЗ «Центральная клиническая больница „РЖД-Медицина“»; ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А. И. Евдокимова» Минздрава РоссииРоссияCentre for Innovative Medical Technologies Co.; Central Clinical Hospital ‘Russian Railways – Medicine; Moscow State University of Medicine and Dentistry n. a. A. I. EvdokimovRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава РоссииРоссияRussian National Research Medical University n. a. N. I. PirogovRussian Federation20220505202215Диагностика и онкотерапия (1)4653Copyright © Медведев С.В., Хачатурян А.В., Романов Д.С., Прокопьева В.В., 20222022Медведев С.В., Хачатурян А.В., Романов Д.С., Прокопьева В.В.Medvedev S.V., Khachaturian A.V., Romanov D.S., Prokopyeva V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2591

Лечение рака мочевого пузыря является важным разделом современной онкологии, учитывая распространенность данного заболевания, а также склонность его к рецидивирующему течению. Для пациентов с диагнозом «мышечно-инвазивный рак мочевого пузыря», радикальная цистэктомия которым не может быть предложена из-за анестезиологических рисков или отказавшихся от нее, трехмодальное лечение, включающее трансуретральную резекцию максимального объема и радикальный курс химиолучевой терапии, выглядит достойной альтернативой радикальному хирургическому вмешательству. Данная статья содержит обзор современной литературы, посвященной озвученному в ней вопросу, а также клинический пример эффективности лучевого лечения у пациента с исходно метастатической формой болезни.

Treatment of bladder cancer is a traditional problem of modern oncology, given the property of this disease to develop in patients of the older age group. For those patients who cannot be offered radical cystectomy because of the anesthetic risks or who refuse it, trimodality therapy, including transurethral resection of the maximum volume and a radical course of chemoradiation therapy, looks like a worthy alternative to radical surgery. This article contains a review of the recent publications on the issue voiced in it, as well as a clinical example of the effectiveness of radiotherapy in a patient with an initially metastatic bladder cancer.

мышечно-инвазивный рак мочевого пузырятрехмодальное лечениелучевая терапияmuscle-invasive bladder cancertrimodality therapyexternal-beam radiotherapyReferencesКаприн А. Д., Старинский В. В., Шахзадова А. О. Состояние онкологической помощи населению в 2019 году. Москва, 2020.Kaprin A. D., Starinskiy V. V., Shachzadova A. O. The condition of cancer care to the population in 2019. Moscow, 2020. (In Russ.)Котов С. В., Хачатрян А. Л., Гуспанов Р. И. и др. Оценка частоты послеоперационных хирургических осложнений у пациентов, подвергшихся радикальной цистэктомии. Онкоурология. 2018; 14 (4): 95–102.Kotov S. V., Khachatryan A. L., Guspanov R. I., et al. Evaluation of surgical complications incidence after radical cystectomy. Cancer Urology. 2018;14(4):95–102. (In Russ.)Матвеев Б. П. Клиническая онкоурология. Москва, АБВ-пресс, 2011. Matveev B. P.Matveev B. P. Clinical oncourology. Moscow, ABV-press, 2011. (In Russ.)NCCN Clinical Practice Guidelines in Oncology. Bladder Cancer. Version 2.2015. http://www.nccn.org/professionals/physician_gls/pdf/bladder.pdfNCCN Clinical Practice Guidelines in Oncology. Bladder Cancer. Version 2.2015. http://www.nccn.org/professionals/physician_gls/pdf/bladder.pdfNovotny V., Froehner M., May M., et al. Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. World Journal of Urology. 2015. Nov; 33 (11): 1753–61. PMID: 25663359. DOI: 10.1007/ s00345–015–1502-y.Novotny V., Froehner M., May M., et al. Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. World Journal of Urology. 2015. Nov; 33 (11): 1753–61. PMID: 25663359. DOI: 10.1007/ s00345–015–1502-y.Ku J. H., Kim M., Jeong C. W., et al. Risk prediction models of locoregional failure after radical cystectomy for urothelial carcinoma: external validation in a cohort of Korean patients. International Journal of Radiation oncology, biology, physics. 2014. Aug 1; 89 (5): 1032–1037. PMID: 25035206. DOI: 10.1016/j.ijrobp.2014.04.049.Ku J. H., Kim M., Jeong C. W., et al. Risk prediction models of locoregional failure after radical cystectomy for urothelial carcinoma: external validation in a cohort of Korean patients. International Journal of Radiation oncology, biology, physics. 2014. Aug 1; 89 (5): 1032–1037. PMID: 25035206. DOI: 10.1016/j.ijrobp.2014.04.049.Christodouleas J. P., Baumann B. C., He J., et al. Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710. Cancer 2014 Apr 15; 120 (8): 1272–80. PMID: 24390799. DOI: 10.1002/cncr.28544.Christodouleas J. P., Baumann B. C., He J., et al. Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710. Cancer 2014 Apr 15; 120 (8): 1272–80. PMID: 24390799. DOI: 10.1002/cncr.28544.Sagros P., Baumann B. C., Eapen L., et al. Risk factors for locoregional recurrence after radical cystectomy of muscle-invasive bladder cancer: A systematic review and frame-work for adjuvant radiotherapy. Cancer Treatment Reviews. 2018. Nov; 70: 88–97. P. 88–97. PMID: 30125800. PMCID: PMC 7441580. DOI: 10.1016/j. ctrv.2018.07.011.Sagros P., Baumann B. C., Eapen L., et al. Risk factors for locoregional recurrence after radical cystectomy of muscle-invasive bladder cancer: A systematic review and frame-work for adjuvant radiotherapy. Cancer Treatment Reviews. 2018. Nov; 70: 88–97. P. 88–97. PMID: 30125800. PMCID: PMC 7441580. DOI: 10.1016/j.ctrv.2018.07.011.Zaghloul M. S., Awwad H. K., Akoush H. H., et al. Postoperative radiotherapy of carcinoma in bilharzial bladder: improved disease-free survival through improving local control. International Journal of Radiation oncology, biology, physics. 1992. 23 (3): 511–7. PMID: 1612951. DOI: 10.1016/0360–3016(92)90005–3.Zaghloul M. S., Awwad H. K., Akoush H. H., et al. Postoperative radiotherapy of carcinoma in bilharzial bladder: improved disease-free survival through improving local control. International Journal of Radiation oncology, biology, physics. 1992. 23 (3): 511–7. PMID: 1612951. DOI: 10.1016/0360–3016(92)90005–3.Zaghloul M. S., Christodouleas J. P., Smith A., et al. Adjuvant Sandwich Chemotherapy Plus Radiotherapy vs Adjuvant Chemotherapy Alone for Locally Advanced Bladder Cancer After Radical Cystectomy. JAMA Surgery. 2018 Jan. 17; 153 (1): e174591. PMID: 29188298. DOI: 10.1001/jamasurg.2017.4591.Zaghloul M. S., Christodouleas J. P., Smith A., et al. Adjuvant Sandwich Chemotherapy Plus Radiotherapy vs Adjuvant Chemotherapy Alone for Locally Advanced Bladder Cancer After Radical Cystectomy. JAMA Surgery. 2018 Jan. 17; 153 (1): e174591. PMID: 29188298. DOI: 10.1001/jamasurg.2017.4591.Iwata T., Kimura S., Abufaraj M., et al. The role of adjuvant radiotherapy after surgery for upper and lower urinary tract urothelial carcinoma: A systematic review. Urologic Oncology. 2019. Oct; 37 (10): 659–671. PMID: 31255542. DOI: 10.1016/j.urolonc.2019.05.021.Iwata T., Kimura S., Abufaraj M., et al. The role of adjuvant radiotherapy after surgery for upper and lower urinary tract urothelial carcinoma: A systematic review. Urologic Oncology. 2019. Oct; 37 (10): 659–671. PMID: 31255542. DOI: 10.1016/j.urolonc.2019.05.021.Shipley W. U., Kaufman D. S., Zehr E., et al. Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer. Urology. 2002. Jul; 60 (1): 62–7. PMID: 12100923. DOI: 10.1016/s0090–4295(02)01650–3.Shipley W. U., Kaufman D. S., Zehr E., et al. Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer. Urology. 2002. Jul; 60 (1): 62–7. PMID: 12100923. DOI: 10.1016/s0090–4295(02)01650–3.Shipley W. U., Winter K. A., Kaufman D. S., et al. Phase III trial of neoadjuvant chemotherapy for patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89–03. Journal of clinical oncology. 1998. Nov; 16 (11): 3576–83. PMID: 9817278. DOI: 10.1200/JCO.1998.16.11.3576.Shipley W. U., Winter K. A., Kaufman D. S., et al. Phase III trial of neoadjuvant chemotherapy for patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89–03. Journal of clinical oncology. 1998. Nov; 16 (11): 3576–83. PMID: 9817278. DOI: 10.1200/JCO.1998.16.11.3576.Rödel C., Weiss C., Sauer R. Trimodality treatment and selective organ preservation for bladder cancer. J Clin Oncol. 2006 Dec 10; 24 (35): 5536–5544. PMID: 17158539. DOI: 10.1200/JCO.2006.07.6729Rödel C., Weiss C., Sauer R. Trimodality treatment and selective organ preservation for bladder cancer. J Clin Oncol. 2006 Dec 10; 24 (35): 5536–5544. PMID: 17158539. DOI: 10.1200/JCO.2006.07.6729Krause F. S., Walter B., Ott O. J. et al. 15-year survival rates after transurethral resection and radiochemotherapy or radiation in bladder cancer treatment. Anticancer Res. 2011 Mar; 31(3): 985–90. PMID: 21498726Krause F. S., Walter B., Ott O. J. et al. 15-year survival rates after transurethral resection and radiochemotherapy or radiation in bladder cancer treatment. Anticancer Res. 2011 Mar; 31(3): 985–90. PMID: 21498726Ott O. J., Rödel C., Weiss C., et al. Radiochemotherapy for bladder cancer. Clin Oncol (R Coll Radiol). 2009 Sep; 21(7): 557–65. PMID: 19564101. DOI: 10.1016/j.clon.2009.05.005.Ott O. J., Rödel C., Weiss C., et al. Radiochemotherapy for bladder cancer. Clin Oncol (R Coll Radiol). 2009 Sep; 21(7): 557–65. PMID: 19564101. DOI: 10.1016/j.clon.2009.05.005.Rödel C., Grabenbauer G. G., Kuhn R., et al. Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. Journal of clinical oncology. 2002. Jul 15; 20 (14): 3061–71. PMID: 12118019. DOI: 10.1200/JCO.2002.11.027.Rödel C., Grabenbauer G. G., Kuhn R., et al. Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. Journal of clinical oncology. 2002. Jul 15; 20 (14): 3061–71. PMID: 12118019. DOI: 10.1200/JCO.2002.11.027.Efstathiou J. A., Spiegel D. Y., Shipley W. U., et al. Long-term outcomes of selective bladder preservation by combined modality therapy for invasive bladder cancer: the MGH experience. European Urology. 2012. Apr; 61 (4): 705–11. PMID: 22101114. DOI: 10.1016/j.eururo.2011.11.010.Efstathiou J. A., Spiegel D. Y., Shipley W. U., et al. Long-term outcomes of selective bladder preservation by combined modality therapy for invasive bladder cancer: the MGH experience. European Urology. 2012. Apr; 61 (4): 705–11. PMID: 22101114. DOI: 10.1016/j.eururo.2011.11.010.Giacalone N. J., Shipley W. U., Clayman R. H., et al. Long-term Outcomes After Bladder-preserving Tri-modality Therapy for Patients with Muscle-invasive Bladder Cancer: An Updated Analysis of the Massachusetts General Hospital Experience. European Urology. 2017. Jun; 71 (6): 952–960. PMID: 28081860. DOI: 10.1016/j.eururo.2016.12.020.Giacalone N. J., Shipley W. U., Clayman R. H., et al. Long-term Outcomes After Bladder-preserving Tri-modality Therapy for Patients with Muscle-invasive Bladder Cancer: An Updated Analysis of the Massachusetts General Hospital Experience. European Urology. 2017. Jun; 71 (6): 952–960. PMID: 28081860. DOI: 10.1016/j.eururo.2016.12.020.Ткачев С. И., Фигурин К. М., Медведев С. В., Матвеев В. Б. Эффективность конформной и конвенциональной лучевой терапии при органосохраняющем лечении больных инвазивным раком мочевого пузыря. Медицинская радиология и радиационная безопасность. 2010. No. 6. С. 39–45.Tkachev S. I., Figurin K. M., Medvedev S. V., Matveev V. B. Efficiency of conformal and conventional radiation therapy in organ-preserving treatment of patients with invasive bladder cancer. Medical radiology and radiation safety. 2010. No. 6. P. 39–45. (In Russ.)Попов А. М., Гришин Г. Н., Доничкина Е. А., Карякин О. Б. Органосохраняющее лечение инвазивного рака мочевого пузыря. Доступно по: http://oncologic.narod.ru/journals/oncouro/ol.htmlPopov A. M., Grishin G. N., Donichkina E. A., Karjakin O. B. Organ-preserving treatment of invasive bladder cancer. Available at: http://oncologic.narod.ru/ journals/oncouro/ol.html (In Russ.)Саллум С. Ж. Органосохраняющее лечение рака мочевого пузыря T2N 0M0. Автореферат диссертации кандидата медицинских наук. Москва; 2005.Sallum S. J. Organ-preserving treatment of bladder cancer T2N 0M0. Abstract of the dissertation of the candidate of medical sciences. Moscow; 2005. (In Russ.)Efstathiou J. A., Bae K., Shipley W. U., et al. Late pelvic toxicity after bladder-sparing therapy in patients with invasive bladder cancer: RTOG 89–03, 95–06, 97–06, 99–06. Journal of clinical oncology. 2009. Sep 1; 27 (25): 4055–61. PMID: 19636019. DOI: 10.1200/JCO.2008.19.5776.Efstathiou J. A., Bae K., Shipley W. U., et al. Late pelvic toxicity after bladder-sparing therapy in patients with invasive bladder cancer: RTOG 89–03, 95–06, 97–06, 99–06. Journal of clinical oncology. 2009. Sep 1; 27 (25): 4055–61. PMID: 19636019. DOI: 10.1200/JCO.2008.19.5776.Williams S. B., Shan Y., Jazzar U., et al. Comparing Survival Outcomes and Costs Associated with Radical Cystectomy and Trimodal Therapy for Older Adults with Muscle-Invasive Bladder Cancer. JAMA Surgery. 2018. Oct 1; 153 (10): 881–889. PMID: 29955780. DOI: 10.1001/jamasurg.2018.1680.Williams S. B., Shan Y., Jazzar U., et al. Comparing Survival Outcomes and Costs Associated with Radical Cystectomy and Trimodal Therapy for Older Adults with Muscle-Invasive Bladder Cancer. JAMA Surgery. 2018. Oct 1; 153 (10): 881–889. PMID: 29955780. DOI: 10.1001/jamasurg.2018.1680.Булычкин П. В., Ткачев С. B., Назаренко А. В., Матвеев В. Б. Способ лучевой терапии больных с рецидивами рака предстательной железы после радикальной простатэктомии с наличием метастазов в регионарные и забрюшинные лимфатические узлы. Доступно по: https://patenton.ru/patent/RU 2711620C 1Bulychkin P. V., Tkachev S. B., Nazarenko A. V., Matveev V. B. The method of radiation therapy for patients with recurrent prostate cancer after radical prostatectomy with the presence of metastases in the regional and retroperitoneal lymphatic nodes. Available at: https://patenton.ru/patent/RU 2711620C 1. (In Russ.)Milano M. T., Biswas T., Simone C.B 2nd, Lo S. S. Oligometastases: history of a hypothesis. Annals of Palliative Medicine. 2021;10(5): 5923–5930. PMID: 32279519. DOI: 10.21037/apm.2020.03.31.Milano M. T., Biswas T., Simone C.B 2nd, Lo S. S. Oligometastases: history of a hypothesis. Annals of Palliative Medicine. 2021;10(5): 5923–5930. PMID: 32279519. DOI: 10.21037/apm.2020.03.31.Guckenberger M., Lievens Y., Bouma A.B, et al. Characterisation and classification of oligometastatic disease: A European society for radiotherapy and oncology and European organization for research and treatment of cancer consensus recommendation. Lancet Oncol. 2020. Jan; 21 (1): e18–e28. PMID: 31908301. DOI: 10.1016/S1470–2045(19)30718–1.Guckenberger M., Lievens Y., Bouma A.B, et al. Characterisation and classification of oligometastatic disease: A European society for radiotherapy and oncology and European organization for research and treatment of cancer consensus recommendation. Lancet Oncol. 2020. Jan; 21 (1): e18–e28. PMID: 31908301. DOI: 10.1016/S1470–2045(19)30718–1.Rompré-Brodeur A., Shinde-Jadhav S., Ayoub M., et al. PD-1/PD-L1 Immune Checkpoint Inhibition with Radiation in Bladder Cancer: In Situ and Abscopal Effects. Molecular cancer therapeutics. 2020 Jan; 19 (1): 211–220. PMID: 31534011. DOI: 10.1158/1535–7163.MCT-18–0986.Rompré-Brodeur A., Shinde-Jadhav S., Ayoub M., et al. PD-1/PD-L1 Immune Checkpoint Inhibition with Radiation in Bladder Cancer: In Situ and Abscopal Effects. Molecular cancer therapeutics. 2020 Jan; 19 (1): 211–220. PMID: 31534011. DOI: 10.1158/1535–7163.MCT-18–0986.Wilkins A., Ost P., Sundahl N. Is There a Benefit of Combining Immunotherapy and Radiotherapy in Bladder Cancer? Clinical Oncology. 2021 Jun; 33 (6): 407–414. PMID: 33726945. DOI: 10.1016/j.clon.2021.02.014.Wilkins A., Ost P., Sundahl N. Is There a Benefit of Combining Immunotherapy and Radiotherapy in Bladder Cancer? Clinical Oncology. 2021 Jun; 33 (6): 407–414. PMID: 33726945. DOI: 10.1016/j.clon.2021.02.014.

The authors declare that there are no conflicts of interest present.