Recent progress in the treatment for urothelial cancer

摘要

Recent progress in the treatment for urothelial cancer is reviewed, especially concerning systemic chemotherapy and surgical techniques. A guideline for chemotherapy of urothelial cancer according to clinical stage is shown on the basis of evidence level in Japan. MVAC chemotherapy is regarded as the gold standard for advanced metastatic urothelial cancer. Randomized controlled trial revealed that gemcitabine in combination with cisplatin (GC therapy) has an efficacy similar to MVAC and is less toxic. Thus, GC therapy will become the standard treatment for advanced metastatic urothelial cancer instead of MVAC. Many chemotherapeutic regimens including gemcitabine and taxane have been introduced for patients with MVAC refractory or recurrent urothelial cancer. It was not yet clarified whether neoadjuvant chemotherapy provides survival benefits. Recent metaanalysis, however, revealed that neoadjuvant chemotherapy, especially cisplatin-based chemotherapy, has a survival advantage compared with total cystectomy alone. Intravesical BCG instillation is the standard treatment for carcinoma in situ and prophylaxis of recurrence for high-risk superficial bladder cancer. For higher efficacy and lower adverse effect, maintenance instillation and low-dose therapy are proposed, respectively, but further investigation is needed. Laparoscopic surgery in the urological field is widely performed and regarded as a minimally invasive surgery. Laparoscopic nephroureterectomy for patients with upper urinary tract cancer is reported to show the same efficacy at point of cancer control in comparison with traditional open surgery. Endoscopic treatment for upper tract urothelial cancer using laser can be safe and effective for a properly selected patient with a normal contralateral kidney.