Cobo M, Delgado R, Gil S, Herruzo I, Baena V, Carabante F, Moreno P, Ruiz J L, Bretón J J, Del Rosal J M, Fuentes C, Moreno P, García E, Villar E, Contreras J, Alés I, Benavides M
Medical Oncology Section, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
Clin Transl Oncol. 2006 Dec;8(12):903-11. doi: 10.1007/s12094-006-0154-1.
Organ preservation has been investigated in patients (p) with infiltrating transitional cell carcinoma (TCC) of the bladder over the past decade as an alternative to radical cystectomy. This is a trimodal schedule study, including transurethral resection of bladder tumor (TURB), neoadjuvant chemotherapy and concomitant radiochemotherapy (RTC).
From April 1996 until August 2005, 29 evaluable patients (p) with T2-T3NXM0 bladder cancer were enrolled. After a transurethral resection of bladder tumor (TURB), we administered 2 cycles of induction chemotherapy with CMV (15 p) or Gemcitabine-Cisplatin (14 p) followed by radiotherapy 45 Gy 1.8 Gy/fraction and two cycles of concomitant cisplatin 70 mg/m(2). 2-3 weeks later, a cystoscopy with tumor-site biopsy was performed. If complete histological response, p were treated with consolidation radiotherapy until 64.8 Gy. For p with residual or recurrent tumor, cystectomy was performed.
We included 28 men and 1 women (median age 63, range 39-72 years) with PS (ECOG) 0-1. The stage was: 21 p T2; 6 p T3a; and 2 p T3b. Toxicity was higher in CMV compared with Gem- Cis: grade (3/4) neutropenia 4/15 (26%) vs 1/14 (7%); febrile neutropenia 3/15 (20%) vs 1/14 (7%); grade (3/4) trombocytopenia 2/15 (13%) vs 1/14 (7%). Toxicities with concomitant RCT were low-moderate: urocystitis (26%) and enteritis (18%).
microscopically complete TURB was obtained in 20 p (69%), but not in 9 p (31%) (7 microscopic, and 2 macroscopic residual tumor). We found a complete histologic response after induction RCT in 25 p (86%). After a median follow-up of 69.4 months (m) (range: 8-97.7), there were 8 deaths, with a overall survival of 72%. Furthermore 14 of 29 p (48%) were alive with intact bladder, and median survival time with intact bladder was 63.6 m (50.1-77.2); were predictive of best outcome T2 stage vs T3 (p < 0.0001), and complete histologic resection in initial TURB vs residual tumor (p = 0.0004).
Combined treatment provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients with TCC. Patients with T2 stage and complete histologic resection in initial TURB had the best outcome.
在过去十年中，已对浸润性膀胱移行细胞癌（TCC）患者的器官保存进行了研究，作为根治性膀胱切除术的替代方法。这是一项三模式方案研究，包括经尿道膀胱肿瘤切除术（TURB）、新辅助化疗和同步放化疗（RTC）。
从1996年4月至2005年8月，纳入了29例可评估的T2 - T3NXM0膀胱癌患者。在经尿道膀胱肿瘤切除术（TURB）后，我们给予2个周期的诱导化疗，采用CMV方案（15例）或吉西他滨 - 顺铂方案（14例），随后进行45 Gy的放疗，每次1.8 Gy，以及2个周期的同步顺铂治疗，剂量为70 mg/m²。2 - 3周后，进行膀胱镜检查及肿瘤部位活检。如果达到完全组织学缓解，患者接受巩固放疗直至64.8 Gy。对于有残留或复发性肿瘤的患者，进行膀胱切除术。
我们纳入了28例男性和1例女性（中位年龄63岁，范围39 - 72岁），体能状态（ECOG）为0 - 1。分期为：21例T2期；6例T3a期；2例T3b期。与吉西他滨 - 顺铂方案相比，CMV方案的毒性更高：3/4级中性粒细胞减少症分别为4/15（26%）对1/14（7%）；发热性中性粒细胞减少症分别为3/15（20%）对1/14（7%）；3/4级血小板减少症分别为2/15（13%）对1/14（7%）。同步RTC的毒性为低 - 中度：膀胱炎（26%）和肠炎（18%）。
20例患者（69%）在显微镜下获得了完全的TURB，但9例患者（31%）未获得（7例显微镜下和2例肉眼可见的残留肿瘤）。在诱导RTC后，25例患者（86%）获得了完全组织学缓解。中位随访69.4个月（范围：8 - 97.7个月）后，有8例死亡，总生存率为72%。此外，29例患者中有14例（48%）膀胱完整存活，膀胱完整的中位生存时间为63.6个月（50.1 - 77.2个月）；T2期与T3期相比（p < 0.0001）以及初始TURB时的完全组织学切除与残留肿瘤相比（p = 0.0004）可预测最佳结局。
联合治疗提供了高缓解率，对于选定的TCC患者可作为根治性膀胱切除术的替代选择。T2期且初始TURB时完全组织学切除的患者预后最佳。
