Abstract

Nearly 50% of bladder cancer patients either present with metastatic disease or relapse distantly following initial local therapy. Prior to platinum-based chemotherapy, the incidence of bladder cancer central nervous system metastases was approximately 1%; however, their incidence has increased to 3–16% following definitive treatment as platinum-based regimens have changed the natural history of the disease. Bladder cancer brain metastases are generally managed similarly to those from more common malignancies such as non-small cell lung cancer, with surgery +/–adjuvant radiotherapy, or radiotherapy alone using stereotactic radiosurgery or whole brain radiotherapy. Limited data suggest that patients with inoperable urothelial carcinoma brain metastases who are not candidates for stereotactic radiosurgery may benefit from shorter whole brain radiation therapy courses compared to other histologies, but data is hypothesis-generating. Given improvements in the efficacy of systemic therapy and supportive care strategies for metastatic urothelial carcinoma translating in improved survival, the incidence of intracranial failures may increase. Immune checkpoint blockade therapy may benefit cisplatin-ineligible metastatic urothelial carcinoma patients as first-line therapy; however, the effectiveness of immune checkpoint blockade to treat central nervous system disease has not been established. In this review, we discuss the incidence and management of bladder cancer brain metastases and considerations regarding variations in management relative to more commonly encountered non-urothelial histologies.

中文翻译：

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评论：膀胱癌的脑转移

摘要

最初局部治疗后，近50％的膀胱癌患者出现转移性疾病或远处复发。在以铂为基础的化学治疗之前，膀胱癌中枢神经系统转移的发生率约为1％。然而，由于铂类疗法已经改变了疾病的自然病程，因此在接受最终治疗后其发病率已上升至3-16％。膀胱癌的脑转移通常与非小细胞肺癌等较常见的恶性肿瘤的转移相似，可通过手术+/-辅助放疗或仅使用立体定向放射手术或全脑放疗进行放射治疗。有限的数据表明，与其他组织学相比，不能进行立体定向放射外科手术的无法手术的尿路上皮癌脑转移患者可以受益于更短的全脑放射治疗疗程，但是数据是基于假设的。鉴于转移性尿路上皮癌的全身治疗和支持治疗策略的改善可改善生存率，颅内衰竭的发生率可能会增加。免疫检查点封锁疗法可作为不适合顺铂治疗的转移性尿路上皮癌患者作为一线治疗；然而，尚未建立免疫检查站封锁治疗中枢神经系统疾病的有效性。在这篇评论中