Bastús R, Caballero J M, González G, Borrat P, Casalots J, Gomez de Segura G, Martí L I, Ristol J, Cirera L
Department of Medical Oncology, Hospital Mutua de Terrassa, Universitat de Barcelona, Spain.
Eur Urol. 1999 Apr;35(4):323-6. doi: 10.1159/000019870.
Small cell carcinoma of the bladder is a rare and highly aggressive tumor. We report our experience with 5 consecutive patients treated with systemic chemotherapy and adjuvant radiotherapy. TNM stages were T2N0M0 (1 patient), T3aN0M0 (3 patients) and T3bN1M0 (1 patient). The chemotherapy protocol was the one used with small cell lung cancer patients at our hospital: six cycles of alternating PE/CAV (PE: cisplatin, etoposide; CAV: cyclophosphamide, doxorubicin, vincristine). Cystoscopy was performed after the third cycle. Four out of 5 patients were free of macroscopic disease. The fifth patient had persistent lesions and was treated by cystectomy. This patient developed a local-regional recurrence 4 months later and died shortly afterwards. Four patients completed the planned six cycles. Cystoscopy with bladder biopsy was then performed on each, and all had complete remission. They were treated with external radiotherapy (45 Gy pelvis, 60 Gy bladder). One patient had invasive bladder recurrence 12 months later and cystectomy was performed. At the last follow-up 42 months later, he was alive and well. The other 3 patients were alive and free of disease 60, 48 and 27 months after diagnosis, respectively. These results are clearly more favorable than previous reports. Cystectomy might, therefore, be unnecessary in some patients.
膀胱小细胞癌是一种罕见且侵袭性很强的肿瘤。我们报告了连续5例接受全身化疗和辅助放疗患者的治疗经验。TNM分期为T2N0M0（1例患者）、T3aN0M0（3例患者）和T3bN1M0（1例患者）。化疗方案采用我院用于小细胞肺癌患者的方案：六个周期交替使用PE/CAV（PE：顺铂、依托泊苷；CAV：环磷酰胺、阿霉素、长春新碱）。第三个周期后进行膀胱镜检查。5例患者中有4例肉眼无病变。第五例患者有持续性病变，接受了膀胱切除术治疗。该患者4个月后出现局部区域复发，随后不久死亡。4例患者完成了计划的六个周期化疗。然后对每例患者进行膀胱活检的膀胱镜检查，结果均为完全缓解。他们接受了体外放疗（盆腔45 Gy，膀胱60 Gy）。1例患者12个月后出现浸润性膀胱复发，接受了膀胱切除术。在42个月后的最后一次随访中，他存活且情况良好。其他3例患者分别在诊断后60、48和27个月存活且无疾病。这些结果明显优于以往的报告。因此，在某些患者中可能无需进行膀胱切除术。
