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Behandlung des Harnblasenkarzinoms im Alter

Treatment of bladder cancer in the elderly

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Zusammenfassung

Hintergrund

Das Harnblasenkarzinom ist in Deutschland beim Mann die vierthäufigste Krebserkrankung, bei der Frau liegt es an 14. Stelle. Drei Viertel der Erkrankungen treten jenseits des 65. Lebensjahres auf.

Thema

Betagte Patienten mit einem nicht-muskelinvasiven Harnblasenkarzinom scheinen ein höheres Rezidiv- und Progressionsrisiko zu haben und sollten ebenso sorgfältig behandelt und überwacht werden wie jüngere Patienten. Ältere Patienten mit muskelinvasivem Harnblasenkarzinom haben im Falle einer radikalen Zystektomie ein erhöhtes perioperatives Morbiditäts- und Mortalitätsrisiko. Sie sollten in erfahrenen Zentren betreut werden.

Schlussfolgerung

Neben der radikalen Zystektomie als Standardtherapie des muskelinvasiven Harnblasenkarzinoms kommen auch blasenerhaltende Verfahren (transurethrale Resektion, Chemotherapie, Strahlentherapie, Radiochemotherapie) zum Einsatz, die in sorgfältig ausgewählten Fällen eine Therapiealternative sein können. Aussagefähige randomisierte Vergleiche fehlen jedoch bisher.

Abstract

Background

In Germany, bladder cancer is the fourth most common malignancy in males, while it occupies the 14th place in females. About 75 % of cases occur in patients aged 65 or more years.

Objectives

Elderly patients with nonmuscle-invasive bladder cancer appear to harbor a higher risk of disease recurrence and progression and should undergo the same treatment and careful surveillance as their younger counterparts. Elderly patients with muscle-invasive bladder cancer undergoing radical cystectomy are at an increased risk of perioperative morbidity and mortality and should be referred to experienced high-volume centers.

Conclusion

Beside radical cystectomy as standard treatment, several bladder-sparing approaches (transurethral resection, chemotherapy, radiotherapy, chemoradiotherapy) are available which may be treatment alternatives in carefully selected cases. Valid randomized comparisons between these approaches and radical cystectomy are, however, still lacking.

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Danksagung

Die Autoren danken Prof. Dr.-Ing. Rainer Koch (em.), Radebeul, für die statistischen Analysen.

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Fröhner und H. Rübben geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie, Universitätsklinikum „Carl Gustav Carus“ der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    M. Fröhner

  2. Klinik und Poliklinik für Urologie, Kinderurologie und Urologische Onkologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    H. Rübben

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  1. M. Fröhner
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  2. H. Rübben
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Correspondence to M. Fröhner.

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Fröhner, M., Rübben, H. Behandlung des Harnblasenkarzinoms im Alter. Urologe 54, 510–515 (2015). https://doi.org/10.1007/s00120-015-3777-4

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  • DOI: https://doi.org/10.1007/s00120-015-3777-4

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