Dunst Jürgen, Diestelhorst Andrea, Kühn Reinhard, Müller Arndt-Christian, Scholz Hans-Jörg, Fornara Paolo
Department of Radiotherapy, Martin Luther University, Halle-Wittenberg, Germany.
Strahlenther Onkol. 2005 Oct;181(10):632-7. doi: 10.1007/s00066-005-1416-5.
Organ-sparing treatment of bladder cancer by a trimodality approach is feasible and effective. In this study, the results of a series of patients are reported, who were, in the majority, not suitable for major surgery.
In the period from June 1995 through December 2003, 68 patients (64 males, four females) with urothelial bladder cancer were treated with curative intent. The median age was 68 years (range 42-82 years). Clinical T-category was 32x T2, 20x T3, and 16x T4. Transurethral resection was performed in all cases, and a complete TUR-BT (transurethral resection of bladder tumor) was attempted, if possible. Radiotherapy was administered in conventional fractionation (five fractions of 1.8 Gy per week) up to 50.4 Gy to bladder, and regional nodes and the whole bladder received a boost up to 54-59.4 Gy. 34 patients received concurrent cisplatin-based chemotherapy (25 mg/m(2) on days 1-5 and 29-33), and patients with impaired renal function were either treated with irradiation alone (n = 7) or received paclitaxel as alternative to cisplatin in a phase II protocol or on an individual decision (n = 27). The median follow-up was 34 months (range 2-104 months).
A histologically confirmed complete remission (CR) on restaging cystoscopy was observed in 40/46 patients (87%) who underwent restaging cystoscopy. CR rates were not significantly correlated to T-category (CR: 24/32 T2, 9/19 T3, and 9/16 T4 tumors) or clinical nodal status. Patients with non-radical resection and macroscopic residual tumor (R2 resection) achieved a CR in only 39% (12/31); this figure was significantly lower as compared to patients with radical R0 TUR-BT (CR: 15/16, 94%, p = 0.013) Furthermore, age and preexisting anemia had no impact on response. The overall survival of the whole group was 45% after 5 years, and survival according to clinical T-category was 62% for T2, 43% for T3, and 19% for T4 (p = 0.015). In eleven patients, local disease progression or relapse was observed. So far, only one salvage cystectomy has been performed, due to contraindications to surgery in the majority of patients.
The data obtained in this study confirm the high efficacy of TUR and radiochemotherapy for locally advanced bladder cancer.
采用三联疗法对膀胱癌进行保器官治疗是可行且有效的。在本研究中，报告了一系列患者的治疗结果，这些患者大多不适合进行大型手术。
1995年6月至2003年12月期间，68例尿路上皮膀胱癌患者（64例男性，4例女性）接受了根治性治疗。中位年龄为68岁（范围42 - 82岁）。临床T分期为32例T2、20例T3和16例T4。所有病例均行经尿道切除术，若可能则尝试完整的经尿道膀胱肿瘤切除术（TUR - BT）。采用常规分割放疗（每周5次，每次1.8 Gy），膀胱剂量达50.4 Gy，区域淋巴结及整个膀胱追加剂量至54 - 59.4 Gy。34例患者接受了基于顺铂的同步化疗（第1 - 5天和第29 - 33天，25 mg/m²），肾功能受损的患者要么仅接受放疗（n = 7），要么在II期方案中或根据个体决定接受紫杉醇替代顺铂治疗（n = 27）。中位随访时间为34个月（范围2 - 104个月）。
在46例接受分期膀胱镜检查的患者中，40例（87%）在组织学上证实达到完全缓解（CR）。CR率与T分期（CR：24/32例T2、9/19例T3和9/16例T4肿瘤）或临床淋巴结状态无显著相关性。非根治性切除且有肉眼残留肿瘤（R2切除）的患者CR率仅为39%（12/31）；与根治性R0 TUR - BT患者相比，这一数字显著更低（CR：15/16，94%，p = 0.013）。此外，年龄和既往贫血对反应无影响。整个组的5年总生存率为45%，根据临床T分期的生存率为T2期62%、T3期43%、T4期19%（p = 0.015）。11例患者出现局部疾病进展或复发。到目前为止，由于大多数患者存在手术禁忌证，仅进行了1例挽救性膀胱切除术。
本研究获得的数据证实了TUR及放化疗对局部晚期膀胱癌的高疗效。
