Department of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain.
Urol Oncol. 2010 Jul-Aug;28(4):368-74. doi: 10.1016/j.urolonc.2009.01.031. Epub 2009 Apr 11.
To update long-term results with selective organ preservation in invasive bladder cancer using aggressive transurethral resection of bladder tumor (TURBT) and radiochemotherapy (RCT) and to identify treatment factors that may predict overall survival (OS).
Between 1990 and 2007, a total of 74 patients with T2-T4 bladder cancer were enrolled in 2 sequential bladder-sparing protocols including aggressive TURB and RCT. From 1990 to 1999, 41 patients were included in protocol no. 1 (P1) that consisted of three cycles of neoadjuvant methotrexate, cisplatin, and vinblastine (MCV) chemotherapy prior to re-evaluation and followed by radiotherapy (RT) 60 Gy in complete responders. Between 2000 and 2007, 33 patients were entered in protocol no. 2 (P2) that consisted of concurrent RCT 64, 8 Gy with weekly cisplatin. In case of invasive residual tumor or recurrence, salvage cystectomy was recommended. Primary endpoints were OS, overall survival with bladder preservation (OSB), and late toxicity.
The mean follow-up for the whole series was 54 months (range 9-156), 69 months for patients in P1 and 36 months for patients in P2. The actuarial 5-year OS and OSB for all series were 72% and 60%, respectively. Distant metastases were diagnosed in 11 (15%) patients. Grade 3 late genitourinary (GU) and intestinal (GI) complications were 5% and 1.3%, respectively. There were no significant differences in the incidence of superficial recurrences (P = 0.080), muscle-invasive relapses (P = 0.722), distant metastasis (P = 0.744), grade >/=2 late complications (P = 0.217 for GU and P = 0.400 for GI), and death among the 2 protocols (P value for OS = 0.643; P value for OSB = 0.532).
These data confirm that trimodality therapy with bladder preservation represents a real alternative to radical cystectomy in selected patients, resulting in an acceptable rate of the long-term survivors retaining functional bladders.
通过积极的经尿道膀胱肿瘤切除术（TURBT）和放化疗（RCT）更新浸润性膀胱癌选择性器官保存的长期结果，并确定可能预测总生存（OS）的治疗因素。
1990 年至 2007 年间，共有 74 例 T2-T4 膀胱癌患者入组 2 项连续的膀胱保留方案，包括积极的 TURBT 和 RCT。1990 年至 1999 年，41 例患者入组方案 1（P1），该方案包括 3 个周期的新辅助甲氨蝶呤、顺铂和长春碱（MCV）化疗，然后在完全缓解者中进行 60Gy 的放疗。2000 年至 2007 年，33 例患者入组方案 2（P2），该方案包括同步 RCT64、8Gy 与每周顺铂。如果有侵袭性残留肿瘤或复发，建议进行挽救性膀胱切除术。主要终点是 OS、保留膀胱的总生存（OSB）和晚期毒性。
整个系列的平均随访时间为 54 个月（范围 9-156），P1 组患者为 69 个月，P2 组患者为 36 个月。所有系列的 5 年 OS 和 OSB 的估计值分别为 72%和 60%。11 例（15%）患者诊断为远处转移。3 级晚期泌尿生殖系统（GU）和胃肠道（GI）并发症分别为 5%和 1.3%。两组浅表复发（P=0.080）、肌肉浸润性复发（P=0.722）、远处转移（P=0.744）、>/=2 级晚期并发症（GU 的 P 值为 0.217，GI 的 P 值为 0.400）发生率无显著差异，以及两种方案之间的死亡（OS 的 P 值=0.643；OSB 的 P 值=0.532）。
这些数据证实，在选择的患者中，膀胱保留的三联疗法是根治性膀胱切除术的一种可行替代方案，可使具有长期生存功能的功能性膀胱保留率达到可接受水平。
