Rozan R, Albuisson E, Donnarieix D, Giraud B, Mazeron J J, Gerard J P, Pernot M, Gerbaulet A, Baillet F, Douchez J
Centre Jean Perrin, Département de Radiothérapie, Clermont-Ferrand, France.
Int J Radiat Oncol Biol Phys. 1992;24(3):469-77. doi: 10.1016/0360-3016(92)91061-q.
Interstitial irradiation is a technique currently used in the treatment of bladder cancer. We report the data on 205 patients (177 men and 28 women) treated in eight French centers. The patients had received the following treatment: a short course of pre-operative pelvic irradiation, followed by surgery consisting of partial cystectomy or tumor resection, and implantation of plastic tubes filled with inactive lead wires, which were replaced by iridium 192 wires. The tumor characteristics were: transitional cell carcinoma, 88.8%; mean size of the tumor, 29 mm; pathological stages: pTis, 1; pT1, 98; pT2, 66; pT3a, 26; pT3b, 9; pT4, 1; unknown, 4 respectively; surgical lymph node status: N+, 3; N-, 118; no node dissection, 84. The mean follow-up was 51 months. Intravesical failures were seen in 35 patients (17.0%), 25 (71.4%) of them without metastases or regional recurrences. Twenty-one patients (10.2%) presented distant metastases, 2/3 of them suffered no bladder relapse. The 5-year survival, calculated according to the Kaplan-Meier method (all causes of death taken together) was 77.4% for the T1, 62.9% for the T2, and 46.8% for the T3. Fifty-three patients had immediate side-effects and three died from surgical complications. Twenty-nine patients had delayed bladder side-effects (haematuria, fistula, chronic cystitis). Six patients presented an ureteral stenosis. Of the disease-free survivors, 96.1% retained the bladder function. Three factors were significantly predictive of delayed side-effects: partial cystectomy, pre-operative radiotherapy total dose, and linear activity of the wires (p < 0.01). Comparing our results to different authors' series interstitial irradiation is likely to provide a high local and general control of the disease and good quality of life in patients with selected tumors.
间质内照射是目前用于治疗膀胱癌的一种技术。我们报告了在法国八个中心接受治疗的205例患者（177例男性和28例女性）的数据。患者接受了以下治疗：术前盆腔短程照射，随后进行手术，包括部分膀胱切除术或肿瘤切除术，并植入填充有非活性铅丝的塑料管，这些铅丝随后被铱192丝取代。肿瘤特征如下：移行细胞癌，88.8%；肿瘤平均大小，29mm；病理分期：pTis，1例；pT1，98例；pT2，66例；pT3a，26例；pT3b，9例；pT4，1例；未知，4例；手术淋巴结状态：N+，3例；N-，118例；未进行淋巴结清扫，84例。平均随访时间为51个月。35例患者（17.0%）出现膀胱内复发，其中25例（71.4%）无转移或局部复发。21例患者（10.2%）出现远处转移，其中2/3未出现膀胱复发。根据Kaplan-Meier方法计算的5年生存率（将所有死亡原因合并计算），T1期为77.4%，T2期为62.9%，T3期为46.8%。53例患者出现即刻副作用，3例死于手术并发症。29例患者出现延迟性膀胱副作用（血尿、瘘管、慢性膀胱炎）。6例患者出现输尿管狭窄。在无病生存者中，96.1%保留了膀胱功能。三个因素对延迟性副作用有显著预测作用：部分膀胱切除术、术前放疗总剂量和铱丝的线性活度（p<0.01）。将我们的结果与不同作者的系列研究进行比较，间质内照射可能对特定肿瘤患者的疾病提供较高的局部和总体控制，并具有良好的生活质量。
