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Korean J Urol Oncol > Volume 13(2); 2015 > Article
The Korean Journal of Urological Oncology 2015;13(2): 66-74.
근침윤성 방광암의 치료 - 술 전 항암화학요법: 새로운 표준치료
권휘안1, 서호경2
1원광대학교 의과대학 원광대 산본병원 비뇨기과, 2국립암센터 전립선암센터
Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care
Whi-An Kwon 1, Ho Kyung Seo 2
1Department of Urology, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Sanbon Hospital, Gunpo, 2Center for Prostate Cancer, National Cancer Center, Goyang, Korea
Published online: August 30, 2015.
ABSTRACT
The standard management for patients with muscle invasive bladder cancer(MIBC) involves radical cystectomy and pelvic lymph node dissection. Although this treatment may be curative, a large proportion of patients will develop recurrence and will ultimately die of metastatic disease. Prospective, randomized clinical trial data demonstrate a survival advantage for those patients who receive neoadjuvant chemotherapy(NAC) prior to radical cystectomy and this concept was confirmed by meta-analysis. The administration of cisplatin-based combination NAC has consistently demonstrated a survival benefit of 5%. The pathologic downstaging is used as a surrogate end point. The efficacy of NAC for MIBC was established primarily with methotrexate, vinblastine, doxorubicin, and cisplatin(MVAC), with complete response rates(pT0) as high as 38%. Dose dense M-VAC(DDMAVC) is preferred over standard MVAC, and gemcitabine/cisplatin is a reasonable alternative to standard M-VAC for NAC. In Korea, while NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice. (Korean J Urol Oncol 2015;13:66-74)
Key Words: Urinary bladder neoplasms; Neoadjuvant therapy; Efficacy; Cisplatin
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