Skip to main content
Erschienen in: Der Urologe 4/2015

01.04.2015 | Leitthema

Therapie des nicht-muskelinvasiven Low-grade-Harnblasenkarzinoms

verfasst von: PD Dr. P.J. Olbert, C.H. Ohlmann, C. Schwentner

Erschienen in: Die Urologie | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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):1–331CrossRef 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):1–331CrossRef
6.
Zurück zum Zitat Bastacky S, Ibrahim S, Wilczynski SP, Murphy WM (1999) The accuracy of urinary cytology in daily practice. Cancer 87(3):118–128CrossRefPubMed Bastacky S, Ibrahim S, Wilczynski SP, Murphy WM (1999) The accuracy of urinary cytology in daily practice. Cancer 87(3):118–128CrossRefPubMed
7.
Zurück zum Zitat 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):304–308CrossRefPubMed 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):304–308CrossRefPubMed
8.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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):675–679CrossRefPubMed 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):675–679CrossRefPubMed
10.
Zurück zum Zitat 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):68–73CrossRefPubMed 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):68–73CrossRefPubMed
11.
Zurück zum Zitat 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):664–669CrossRefPubMed 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):664–669CrossRefPubMed
12.
Zurück zum Zitat 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):62–67CrossRefPubMed 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):62–67CrossRefPubMed
13.
Zurück zum Zitat 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):226–229CrossRefPubMed 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):226–229CrossRefPubMed
14.
Zurück zum Zitat 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):862–866CrossRefPubMed 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):862–866CrossRefPubMed
15.
Zurück zum Zitat Schmidbauer J, Witjes F, Schmeller N et al (2004) Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy. J Urol 171(1):135–138CrossRefPubMed Schmidbauer J, Witjes F, Schmeller N et al (2004) Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy. J Urol 171(1):135–138CrossRefPubMed
16.
Zurück zum Zitat 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):1907–1913CrossRefPubMedCentralPubMed 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):1907–1913CrossRefPubMedCentralPubMed
17.
Zurück zum Zitat 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):1025–1028CrossRefPubMed 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):1025–1028CrossRefPubMed
18.
Zurück zum Zitat 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):1121–1123CrossRefPubMed 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):1121–1123CrossRefPubMed
19.
Zurück zum Zitat 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):702–705CrossRefPubMed 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):702–705CrossRefPubMed
20.
Zurück zum Zitat 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):658–663CrossRefPubMed 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):658–663CrossRefPubMed
21.
Zurück zum Zitat Herr HW (2010) Narrow-band imaging cystoscopy to evaluate the response to bacille Calmette-Guerin therapy: preliminary results. BJU Int 105(3):314–316CrossRefPubMed Herr HW (2010) Narrow-band imaging cystoscopy to evaluate the response to bacille Calmette-Guerin therapy: preliminary results. BJU Int 105(3):314–316CrossRefPubMed
22.
Zurück zum Zitat Herr HW, Donat SM (2011) Reduced bladder tumour recurrence rate associated with narrow-band imaging surveillance cystoscopy. BJU Int 107(3):396–398CrossRefPubMed Herr HW, Donat SM (2011) Reduced bladder tumour recurrence rate associated with narrow-band imaging surveillance cystoscopy. BJU Int 107(3):396–398CrossRefPubMed
23.
Zurück zum Zitat 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):1111–1114CrossRefPubMed 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):1111–1114CrossRefPubMed
24.
Zurück zum Zitat 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):908–913CrossRefPubMed 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):908–913CrossRefPubMed
25.
Zurück zum Zitat 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):36–44CrossRefPubMed 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):36–44CrossRefPubMed
26.
Zurück zum Zitat 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):2134–2137CrossRefPubMed 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):2134–2137CrossRefPubMed
27.
Zurück zum Zitat Adiyat KT, Katkoori D, Soloway CT et al (2010) „Complete transurethral resection of bladder tumor“: are the guidelines being followed? Urology 75(2):365–367CrossRefPubMed Adiyat KT, Katkoori D, Soloway CT et al (2010) „Complete transurethral resection of bladder tumor“: are the guidelines being followed? Urology 75(2):365–367CrossRefPubMed
28.
Zurück zum Zitat 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):2186–2190CrossRefPubMed 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):2186–2190CrossRefPubMed
29.
Zurück zum Zitat 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):517–521CrossRef 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):517–521CrossRef
30.
Zurück zum Zitat 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):773–780CrossRefPubMed 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):773–780CrossRefPubMed
31.
Zurück zum Zitat 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):485–490CrossRefPubMed 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):485–490CrossRefPubMed
32.
Zurück zum Zitat 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):484–492CrossRefPubMed 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):484–492CrossRefPubMed
33.
Zurück zum Zitat Soloway MS (2006) Expectant treatment of small, recurrent, low-grade, noninvasive tumors of the urinary bladder. Urol Oncol 24(1):58–61CrossRefPubMed Soloway MS (2006) Expectant treatment of small, recurrent, low-grade, noninvasive tumors of the urinary bladder. Urol Oncol 24(1):58–61CrossRefPubMed
Metadaten
Titel
Therapie des nicht-muskelinvasiven Low-grade-Harnblasenkarzinoms
verfasst von
PD Dr. P.J. Olbert
C.H. Ohlmann
C. Schwentner
Publikationsdatum
01.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Urologie / Ausgabe 4/2015
Print ISSN: 2731-7064
Elektronische ISSN: 2731-7072
DOI
https://doi.org/10.1007/s00120-015-3773-8

Weitere Artikel der Ausgabe 4/2015

Der Urologe 4/2015 Zur Ausgabe

Mitteilungen der DGU

Mitteilungen der DGU

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.