Chung Peter W M, Bristow Robert G, Milosevic Michael F, Yi Qi-long, Jewett Michael A S, Warde Padraig R, Catton Charles N, McLean Michael, Moore Malcolm, Tannock Ian F, Gospodarowicz Mary K
Department of Radiation Oncology, Princess Margaret Hospital, University Health Network and University of Toronto, Toronto, Ontario M5G 2M9, Canada.
Urol Oncol. 2007 Jul-Aug;25(4):303-9. doi: 10.1016/j.urolonc.2006.09.015.
To report the long-term results and examine factors associated with bladder preservation, risk of relapse, and survival in patients treated with radical radiotherapy for invasive bladder cancer.
Between 1986 and 1997, 340 patients with T1-T4 bladder cancer were treated at Princess Margaret Hospital and received radiotherapy alone, radiotherapy and concurrent cisplatin chemotherapy, or neoadjuvant chemotherapy followed by radiotherapy. Patients having complete response were followed with regular cystoscopy. Cystectomy was undertaken in suitable patients with persistent or locally recurrent disease.
The median age of patients was 71 years, 13% had evidence of regional lymph node involvement, and 27% were medically unfit for radical cystectomy. A total of 247 patients received radiotherapy alone, 36 radiotherapy and concurrent cisplatin chemotherapy, and 57 neoadjuvant chemotherapy followed by radiotherapy. Complete response was obtained in 63.5% of patients overall, and median follow-up was 7.9 years. The 10-year overall survival, cause-specific survival, and local relapse-free rates were 19%, 35%, and 32%, respectively. In 131 patients with muscle-invasive disease confined to the bladder wall (T2N0M0), 10-year cause-specific survival (P = 0.02) and local relapse-free rates (P = 0.03) were 68% and 60% when carcinoma in situ was absent, and 47% and 28%, respectively, when present. In multivariable analysis, younger age, lower T category, and absence of carcinoma in situ were associated with a statistically significant improvement in survival and local control (P <or= 0.01). The majority of survivors beyond 5 years had an intact bladder.
Radiotherapy based treatment is an alternative to radical cystectomy for long-term local control with bladder preservation and can be applied in select patients. Optimization of radiotherapy delivery in combination with newer systemic and molecular targeted therapies may allow for future improvements and adoption of an organ preservation strategy for a larger number of patients with bladder cancer.
报告根治性放疗治疗浸润性膀胱癌患者的长期结果，并研究与膀胱保留、复发风险及生存相关的因素。
1986年至1997年间，340例T1 - T4期膀胱癌患者在玛格丽特公主医院接受治疗，单独接受放疗、放疗联合顺铂同步化疗或新辅助化疗后再行放疗。对完全缓解的患者定期进行膀胱镜检查。对疾病持续或局部复发的合适患者进行膀胱切除术。
患者的中位年龄为71岁，13%有区域淋巴结受累证据，27%因医学原因不适于行根治性膀胱切除术。共有247例患者单独接受放疗，36例接受放疗联合顺铂同步化疗，57例接受新辅助化疗后再行放疗。总体上63.5%的患者获得完全缓解，中位随访时间为7.9年。10年总生存率、病因特异性生存率和局部无复发生存率分别为19%、35%和32%。在131例局限于膀胱壁的肌层浸润性疾病（T2N0M0）患者中，原位癌不存在时，10年病因特异性生存率（P = 0.02）和局部无复发生存率（P = 0.03）分别为68%和60%；原位癌存在时，分别为47%和28%。多变量分析显示，年龄较小、T分期较低和不存在原位癌与生存及局部控制的统计学显著改善相关（P≤0.01）。超过5年的大多数幸存者膀胱完整。
基于放疗的治疗是根治性膀胱切除术的替代方案，可实现长期局部控制并保留膀胱，可应用于特定患者。优化放疗方案并结合更新的全身及分子靶向治疗可能会在未来取得进展，并使更多膀胱癌患者能够采用器官保留策略。
