Otto emphasizes the need for rational patient selection regarding the indication for surgical resection of metastases in advanced bladder cancer, which is entirely consistent with our article. As we pointed out, resection is indicated only in the following patients:
- Patients in whom complete resectability of the metastases is guaranteed
- Patients in whom a significant response to preceding chemotherapy was observed
- Patients whose general health is otherwise good.
The study of 70 patients cited by Otto does not contradict our statements since
- none of the 70 patients had responded to initial MVAC chemotherapy
- 76% of patients had metastases in multiple locations
- no selection of patients was done as far as the indication for surgical resection of the metastases is concerned. This is also obvious from the high perioperative mortality of 4%.
In sum, surgical resection of metastases in bladder cancer, with the aim of long-term control, is indicated only in patients with a significant response to primary systemic chemotherapy and in whom complete resectability of the metastases is a given.
Prof. Dr. med. Axel Heidenreich
Universitätsklinikum der RWTH Aachen
Conflict of interest statement
Professor Heidenreich has received lecture fees and is a member of the Advisory Board of AMGEN, Astellas, Bayer AG, GlaxoSmithKline, Janssen-Cilag, Sanofi Aventis, and Takeda. He has received honoraria from Ferring and Pfizer. He sits on the advisory board of IPSEN.
|1.||Heidenreich A, Wilop S, Pinkawa M, Porres D, Pfister D: Surgical resection of urological tumor metastases following medical treatment. Dtsch Arztebl Int 2012; 109(39): 631–7 VOLLTEXT|