Pedraza V, Cueto J, Castillo I, Gonzalo C, Romero M J, Zuluaga A
Servicio de Radioterapia, Hospital Clinico Universitario, Granada, España.
Arch Esp Urol. 1999 Jul-Aug;52(6):662-74.
To review the treatment of invasive bladder cancer with ionizing radiation.
Patient selection criteria, prognostic factors, treatment of different tumor types with radiation using different strategies alone or in combination with chemotherapy are analyzed in the literature.
RESULTS/CONCLUSIONS: The role of radiotherapy in the treatment of invasive carcinoma of the bladder is crucial: 1) preoperative radiotherapy in combination with radical surgery achieves results comparable with those of cystectomy in terms of survival and a higher local control rate; 2) used in combination with cisplatin post-TUR, irradiation is highly effective for local control of the tumor and bladder preservation, with complete remission rates ranging from 60-70%, which are higher than those of radical cystectomy; 3) in this latter therapeutic modality the effect of radiotherapy is dose-related and is influenced by factors such as tumor size, presence or absence of urinary obstruction, presence of multiple lesions on the bladder wall and extravesical spread. Over the last few years, a number of therapeutic procedures have been developed, which can improve the previously mentioned results when used appropriately. Among these are hyperfractionation, accelerated irradiation and concomitant radio and chemotherapy. Studies to determine tumor radiosensitivity (Fs2/a) and the use of gene therapy could enhance the tumor control rate in the future, although a system for the selection on patients for conservative or multilating treatment based on clinical, clinicopathological and scientific criteria will have to be developed. Finally, the use of special techniques, particularly brachytherapy and intraoperative irradiation, in combination with external radiotherapy has achieved excellent results (high local control and survival rates) in certain situations, basically in single/small-sized tumours.
回顾电离辐射治疗浸润性膀胱癌的情况。
分析文献中患者的选择标准、预后因素、采用不同策略单独或联合化疗进行放射治疗不同肿瘤类型的情况。
结果/结论：放射治疗在浸润性膀胱癌治疗中的作用至关重要：1）术前放疗联合根治性手术在生存率和局部控制率方面取得的结果与膀胱切除术相当；2）经尿道膀胱肿瘤电切术后联合顺铂使用，放疗对肿瘤局部控制和膀胱保留非常有效，完全缓解率为60% - 70%，高于根治性膀胱切除术；3）在这种治疗方式中，放疗效果与剂量相关，并受肿瘤大小、是否存在尿路梗阻、膀胱壁上是否存在多个病灶以及膀胱外扩散等因素影响。在过去几年中，已经开发了一些治疗方法，如适当使用可改善上述结果。其中包括超分割放疗、加速放疗以及同步放化疗。确定肿瘤放射敏感性（Fs2/a）的研究和基因治疗的应用未来可能会提高肿瘤控制率，不过必须建立一个基于临床、临床病理和科学标准选择保守或根治性治疗患者的系统。最后，在某些情况下，特别是近距离放疗和术中放疗与外照射联合使用，在单/小尺寸肿瘤方面取得了优异的结果（高局部控制率和生存率）。
