Тримодальная органосохраняющая терапия мышечно-инвазивного рака мочевого пузыря

Цель исследования. Обобщение мирового  опыта органосохраняющего лечения мышечно‑инвазивного рака мочевого  пузыря

Материал и методы. Поиск  литературы  производился   в системах Medline, Cochrane Library, Elibrary и PubMed, включались публикации, характеризующие современные  возможности  органосохраняющего лечения мышечно‑инвазивного рака мочевого пузыря, 58 из которых были   использованы для написания данного обзора.

Результаты. В обзоре освещены   результаты  международных рандомизированных и значимых нерандомизированных исследований органосохраняющего лечения  мышечно‑инвазивного рака мочевого  пузыря. Особое внимание  уделено описанию современной комбинации методов лечения для достижения ее максимальной эффективности   с сохранением качества  жизни пациентов. Проведен  анализ мировой   литературы, подтверждающий перспективность  органосохраняющего лечения при  тщательном отборе пациентов.

Заключение. Органосохраняющая  тримодальная терапия мышечно‑инвазивного рака мочевого  пузыря  остается альтернативной лечебной стратегией. Ключевую   роль играет тщательный отбор пациентов. Современный   подход к проведению   тримодальной терапии (ТМТ) следующий: должна выполняться  полная  трансуретральная резекция  (ТУР), неоадъювантная или адъювантная химиотерапия, последующая оценка   ответа на  лечение    (ре-стадирование при помощи   ТУР); при полном патоморфологическом ответе – курс дистанционной лучевой терапии до СОД  60–66 Гр в случае  традиционного фракционирования   (также возможны фокальная  лучевая терапия и использование режимов гипофракционирования), с использованием современных технологий облучения (IGRT, IMRT). В  случае неполного    ответа показано   выполнение  радикальной цистэктомии (РЦЭ). При возникновении рецидива   в процессе наблюдения после выполнения   лечения  в объеме   ТМТ   показана  спасительная РЦЭ.

При соблюдении вышеописанных условий  онкологические результаты лечения при помощи ТМТ эквивалентны таковым при проведении РЦЭ, однако требуют дальнейшего изучения.

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