Rödel C, Dunst J, Grabenbauer G G, Kühn R, Papadopoulos T, Schrott K M, Sauer R
Department of Radiation Oncology, University of Erlangen, Germany.
Strahlenther Onkol. 2001 Feb;177(2):82-8; discussion 89. doi: 10.1007/pl00002387.
Current treatment options for high-risk superficial T1-bladder cancer (Grade 3, associated Tis, multifocality, tumor diameter > 5 cm or multiple recurrences) include early cystectomy or the goal of organ preservation by adjuvant intravesical therapy after transurethral resection (TURB). We have evaluated the efficacy of adjuvant radiotherapy or radiochemotherapy on local control, bladder preservation, recurrence rate and long-term survival after TURB of high-risk T1-bladder cancer.
From May 1982 to May 1999, a total of 74 patients with T1-bladder cancer were treated by either radiotherapy (n = 17) or concomitant radiochemotherapy (n = 57) after TURB. Radiotherapy was initiated 4 to 8 weeks after TURB; a median dose of 54 (range: 45 to 60) Gy was applied to the bladder with daily fractions of 1.8 to 2.0 Gy. Since 1985 chemotherapy has been given in the 1st and 5th week of radiotherapy and consisted of cisplatin (25 mg/m2/d) in 33 patients, carboplatin (65 mg/m2/d) was administered in 14 patients with decreased creatine clearance (< 50 ml/min). Since 1993 a combination of cisplatin (20 mg/m2/d) and 5-fluorouracil (600 mg/m2/d) was applied to 10 patients. Salvage cystectomy was recommended for patients with refractory disease or invasive recurrences. At the time of analysis, the median follow-up for surviving patients was 57 (range: 3 to 174) months.
After radiotherapy/radiochemotherapy, a complete remission at restaging TURB was achieved in 62 patients (83.7%), 35 of whom (47% with regard to the total cohort of the 74 treated patients) have been continuously free of tumor, 11 patients (18%) experienced a superficial relapse and 16 patients (26%) showed tumor progression after initial complete response. Overall-survival was 72% at 5 years and 50% at 10 years with 77% of the surviving patients maintaining their own bladder at 5 years. Negative prognostic factors for cancer-specific survival were non-complete (R1/2) initial TURB (p = 0.12) and recurrent disease (p = 0.07); combined radiochemotherapy was more effective than radiotherapy alone (p = 0.1).
Adjuvant radiotherapy/radiochemotherapy offers an additional option in high-risk superficial bladder cancer with a high chance of cure and bladder preservation. The ultimate value of radiotherapy in comparison with other treatment options should be determined in randomized trials.
高危浅表性T1期膀胱癌（3级、合并Tis、多灶性、肿瘤直径>5 cm或多次复发）的当前治疗选择包括早期膀胱切除术或经尿道切除术（TURB）后通过辅助膀胱内治疗实现器官保留的目标。我们评估了辅助放疗或放化疗对高危T1期膀胱癌TURB后局部控制、膀胱保留、复发率和长期生存的疗效。
1982年5月至1999年5月，共有74例T1期膀胱癌患者在TURB后接受了放疗（n = 17）或同步放化疗（n = 57）。放疗在TURB后4至8周开始；膀胱接受的中位剂量为54（范围：45至60）Gy，每日分次剂量为1.8至2.0 Gy。自1985年以来，在放疗的第1周和第5周进行化疗，33例患者使用顺铂（25 mg/m2/d），14例肌酐清除率降低（<50 ml/min）的患者使用卡铂（65 mg/m2/d）。自1993年以来，10例患者使用顺铂（20 mg/m2/d）和5-氟尿嘧啶（600 mg/m2/d）联合方案。对于难治性疾病或浸润性复发的患者，建议行挽救性膀胱切除术。在分析时，存活患者的中位随访时间为57（范围：3至174）个月。
放疗/放化疗后，62例患者（83.7%）在再次分期TURB时达到完全缓解，其中35例（占74例治疗患者总数的47%）一直无肿瘤，11例患者（18%）出现浅表复发，16例患者（26%）在初始完全缓解后出现肿瘤进展。5年总生存率为72%，10年为50%，77%的存活患者在5年时保留了自己的膀胱。癌症特异性生存的不良预后因素为初始TURB不完全（R1/2）（p = 0.12）和复发性疾病（p = 0.07）；同步放化疗比单纯放疗更有效（p = 0.1）。
辅助放疗/放化疗为高危浅表性膀胱癌提供了另一种选择，治愈和保留膀胱的机会较高。放疗与其他治疗选择相比的最终价值应在随机试验中确定。
