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[French ccAFU guidelines - Update 2018-2020: Bladder cancer]
- Source :
- Progrès en Urologie, Progrès en Urologie, Elsevier Masson, 2018, 28 (12), pp.S46-S78. ⟨10.1016/j.purol.2018.07.283⟩
- Publication Year :
- 2018
- Publisher :
- HAL CCSD, 2018.
-
Abstract
- International audience; OBJECTIVE:To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers.METHODS:A Medline search was achieved between 2015 and 2018, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.RESULTS:Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival.CONCLUSION:These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.
- Subjects :
- 0301 basic medicine
Bladder neoplams
medicine.medical_specialty
Cytologie urinaire
Survival
Urology
medicine.medical_treatment
Bladder
MESH: Societies, Medical
030232 urology & nephrology
Vessie
[SDV.CAN]Life Sciences [q-bio]/Cancer
Pembrolizumab
Cystectomy
Ureterostomy
03 medical and health sciences
0302 clinical medicine
medicine
BCG
Contraindication
Cancer
MESH: Medical Oncology
Chemotherapy
Bladder cancer
MESH: Humans
business.industry
Urinary diversion
Carcinome urothélial
medicine.disease
3. Good health
MESH: Urinary Bladder Neoplasms
MESH: France
Dissection
030104 developmental biology
Survie
MESH: Practice Patterns, Physicians'
Cystectomie
Urothelial carcinoma
business
Cytology
Tumeurs de la vessie
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Subjects
Details
- Language :
- French
- ISSN :
- 11667087
- Database :
- OpenAIRE
- Journal :
- Progrès en Urologie, Progrès en Urologie, Elsevier Masson, 2018, 28 (12), pp.S46-S78. ⟨10.1016/j.purol.2018.07.283⟩
- Accession number :
- edsair.doi.dedup.....3c1b23b2320b81ed81bce7c95487c9f6