Kageyama Y, Okada Y, Arai G, Hyochi N, Suzuki M, Masuda H, Hayashi T, Kawakami S, Okuno T, Ishizaka K, Kihara K
Department of Urology and Reproductive Medicine, Graduate School Tokyo Medical and Dental University, Japan.
Jpn J Clin Oncol. 2000 Dec;30(12):553-6. doi: 10.1093/jjco/hyd138.
Good local control has been reported in cases of muscle-invasive bladder cancer treated by chemoradiotherapy and transurethral resection (TUR). However, definitive irradiation or extensive chemotherapy is often intolerable for elderly or poor-risk patients. We report here benefits of partial cystectomy after concurrent low-dose chemoradiotherapy for high-risk patients.
Thirty-seven patients with localized muscle-invasive bladder cancer (T2-T4) were treated with concurrent cisplatin (50-100 mg/body x 2 courses) and pelvic irradiation (40 Gy) preoperatively. Among 17 patients (46%) who achieved complete response (CR), 10 were not suitable for radical cystectomy and underwent partial cystectomy. Radical cystectomy was performed in 24 cases [CR = 6, partial response (PR) = 18]. Two patients (one CR and one PR) rejected open surgery and were treated by TUR of the primary site. One no change (NC) patient received no further treatment because of mental disorder.
Median follow-up was 12 months (range 2-37 months). Fifteen of 36 evaluable cases (42%) achieved a pathological T0 response (no residual tumor). Estimated 3-year disease-free survival was 56% for all patients and 100% for T0 responders. Seven of 21 patients with pathological persistent tumor developed local recurrence (three patients) or distant metastasis (four patients). All of the 10 patients (eight with T0 response and two with a small residual tumor nest) who underwent partial cystectomy were recurrence-free for an observation period of up to 3 years.
Bladder preservation by partial cystectomy may be a choice for patients who show a good response to preoperative chemoradiotherapy and are not suitable for radical cystectomy.
据报道，采用放化疗及经尿道切除术（TUR）治疗的肌层浸润性膀胱癌患者可获得良好的局部控制。然而，对于老年或高危患者而言，根治性放疗或广泛化疗往往难以耐受。我们在此报告高危患者在同步低剂量放化疗后行膀胱部分切除术的益处。
37例局限性肌层浸润性膀胱癌（T2-T4）患者术前接受顺铂（50-100mg/体，共2个疗程）同步盆腔照射（40Gy）治疗。在17例（46%）达到完全缓解（CR）的患者中，10例不适合行根治性膀胱切除术，接受了膀胱部分切除术。24例行根治性膀胱切除术[CR = 6例，部分缓解（PR）= 18例]。2例患者（1例CR和1例PR）拒绝开放手术，接受了原发部位的经尿道切除术。1例病情无变化（NC）的患者因精神障碍未接受进一步治疗。
中位随访时间为12个月（范围2-37个月）。36例可评估病例中有15例（42%）达到病理T0反应（无残留肿瘤）。所有患者的3年无病生存率估计为56%，T0反应者为100%。21例病理持续存在肿瘤的患者中有7例发生局部复发（3例患者）或远处转移（4例患者）。接受膀胱部分切除术的10例患者（8例T0反应者和2例有小残留肿瘤巢者）在长达3年的观察期内均无复发。
对于术前放化疗反应良好且不适合行根治性膀胱切除术的患者，膀胱部分切除术保留膀胱可能是一种选择。
