De Neve W, Lybeert M L, Goor C, Crommelin M A, Ribot J G
Department of Radiotherapy, Academic Hospital, Free University Brussels, Belgium.
Int J Radiat Oncol Biol Phys. 1992;23(2):299-304. doi: 10.1016/0360-3016(92)90745-4.
Between January 1974 and December 1984, 273 consecutive patients with cancer of the urinary bladder, Stages T1 or T2, any N, M0, were referred to the radiotherapy department of the Catharina Hospital at Eindhoven, The Netherlands and 265 were treated in a non-randomized fashion according to one of the three following schedules: 137 patients (67 T1, 70 T2) received radiotherapy only; 96 (44 T1, 52 T2) had preoperative radiotherapy followed by cystectomy and diversion according to the Bricker technique in 94/96; 32 patients (13 T1, 19 T2) had low total dose (12 Gy median) external radiotherapy followed by an interstitial cesium implant. The external radiotherapy fields included the pelvic structures. Total dose was 64 Gy median in the radiotherapy-only group and 40 Gy median in the preoperative irradiated group. The median follow-up in survivors was 81 months (range: 15-203). Locoregional relapse was observed in 50% in the group treated by external radiotherapy alone versus 17% in the group treated by preoperative radiation plus surgery and 28% of the patients who received cesium implant. During follow-up, 106/137 (77%), 67/96 (70%) and 13/32 (41%) patients died. In the radiotherapy-alone group, 38 died from intercurrent diseases, 36 from bladder cancer, two from therapy-related complications and cause of death was unknown in 30 patients. In the preoperative radiation group, the figures were 17 for intercurrent deaths, 26 related to progressive bladder cancer, 14 died due to perioperative complications and cause of death was unknown in 10. Cause of death was intercurrent in six and due to bladder cancer in seven patients treated by cesium implant. Probability of survival (calculated from the date of histological diagnosis) for the whole group, with censoring death to intercurrent disease was 53% at 5 years (56% for T1; 51% for T2) and 41% (40% for T1; 43% for T2) at 10 years. No significant difference was observed between T1 and T2 (p = 0.76). Survival in the treatment subgroups was, for patients treated by external radiotherapy only: 50% at 5 years and 33% at 10 years; for patients treated by external radiotherapy and surgery: 49% at 5 years and 42% at 10 years; for patients treated by cesium implant: 76% at 5 years and 76% at 10 years. Survival of patients in the cesium implant group was significantly better than in the other groups (p = 0.0001). Following variables were analyzed using the Cox proportional hazards model: age, gender, T1 or T2 stage, grade, cesium implant or not, and surgery or not.(ABSTRACT TRUNCATED AT 400 WORDS)
1974年1月至1984年12月期间，荷兰埃因霍温市卡塔里娜医院放疗科共收治了273例连续性膀胱癌患者，分期为T1或T2，任何N分期，M0，其中265例患者按以下三种方案之一进行了非随机治疗：137例患者（67例T1期，70例T2期）仅接受放疗；96例（44例T1期，52例T2期）接受术前放疗，随后94/96例患者根据布里克技术行膀胱切除术和改道术；32例患者（13例T1期，19例T2期）接受低总剂量（中位剂量12 Gy）外照射放疗，随后行铯间质植入。外照射放疗野包括盆腔结构。仅接受放疗组的总剂量中位值为64 Gy，术前放疗组为40 Gy。存活患者的中位随访时间为81个月（范围：15 - 203个月）。单纯外照射放疗组局部区域复发率为50%，术前放疗加手术组为17%，接受铯植入的患者为28%。随访期间，106/137（77%）、67/96（70%）和13/32（41%）的患者死亡。仅接受放疗组中，38例死于并发疾病，36例死于膀胱癌，2例死于治疗相关并发症，30例死因不明。术前放疗组中，并发疾病死亡17例，进展性膀胱癌相关死亡26例，围手术期并发症死亡14例，10例死因不明。接受铯植入治疗的患者中，并发疾病导致死亡6例，膀胱癌导致死亡7例。全组患者（从组织学诊断日期开始计算），因并发疾病死亡进行截尾后的5年生存率为53%（T1期为56%；T2期为51%），10年生存率为41%（T1期为40%；T2期为43%）。T1期和T2期之间未观察到显著差异（p = 0.76）。各治疗亚组的生存率分别为：仅接受外照射放疗的患者5年生存率为50%，10年生存率为33%；接受外照射放疗和手术的患者5年生存率为49%，10年生存率为42%；接受铯植入的患者5年生存率为76%，10年生存率为76%。铯植入组患者的生存率显著高于其他组（p = 0.0001）。使用Cox比例风险模型分析了以下变量：年龄、性别、T1或T2分期、分级、是否接受铯植入以及是否接受手术。（摘要截断于400字）
