Henningsohn Lars, Wijkström Hans, Dickman Paul W, Bergmark Karin, Steineck Gunnar
Clinical Cancer Epidemiology, Department of Oncology and Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden.
Radiother Oncol. 2002 Feb;62(2):215-25. doi: 10.1016/s0167-8140(01)00455-8.
Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function. Here we studied symptoms, symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy.
We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995. For comparison, 325 patients treated with radical cystectomy and urostomy, continent or non-continent, during the same period and 460 individuals randomly selected from the general population were included. Information was collected by means of an anonymously answered postal questionnaire to avoid investigator-related bias.
Answers were obtained from 58 (82%) radiated patients, 251 (85%) cystectomized patients and 310 (71%) population controls. Of the radiated patients, 74% reported little or no distress from symptoms from the urinary tract, 38% had had intercourse the previous month and 57% (men) reported they had ejaculated. Among the cystectomized patients, 13% had had intercourse and 0% (men) had ejaculated. Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32% of the radiated patients, 24% of the cystectomized patients and 9% of the population controls. After radical radiotherapy, 46% of the patients were willing to accept some risk of decreased survival to become symptom-free.
About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract. The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable.
肌肉浸润性膀胱癌的根治性放疗可使肿瘤灭活并保留器官功能。在此，我们研究了长期幸存者的症状、症状困扰及权衡情况，并将数据与人群对照组和接受膀胱切除术的患者进行了比较。
我们确定了71例在1995年前接受根治性放疗的膀胱癌患者。为作比较，纳入了同期接受根治性膀胱切除术及尿流改道术（可控或不可控）的325例患者，以及从普通人群中随机选取的460人。通过匿名邮寄问卷收集信息，以避免调查者相关偏倚。
58例（82%）接受放疗的患者、251例（85%）接受膀胱切除术的患者和310例（71%）人群对照组提供了答复。接受放疗的患者中，74%报告尿路症状很少或没有困扰，38%上个月有过性行为，57%（男性）报告有射精。在接受膀胱切除术的患者中，13%有过性行为，0%（男性）有射精。32%接受放疗的患者、24%接受膀胱切除术的患者和9%人群对照组报告有中度或重度胃肠道症状困扰。根治性放疗后，46%的患者愿意接受一定的生存风险降低以摆脱症状。
这些膀胱癌根治性放疗后的长期幸存者中，约3/4的患者膀胱功能良好，尿路症状很少或没有困扰。性功能障碍的发生率低于膀胱切除术后，胃肠道症状困扰的发生率相当。
