Kakehi Y, Nishio Y, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
Urol Int. 1991;47 Suppl 1:120-2. doi: 10.1159/000282269.
To improve cure rates of locally invasive bladder cancer patients, we have performed radiation therapy prior to radical cystectomy in 88 patients since 1980. Until 1984, a total dose of 40 Gy for 4 weeks had been irradiated to the pelvic cavity of 46 patients, while 24 Gy with or without hyperthermia for 2 weeks has been applied to 42 patients since 1985. The treatment efficacy was assessed histopathologically according to the evaluation system proposed by Shimosato et al. in 1971. Approximately 50% of the patients responded well to this preoperative therapy. Among these patients, those with pT3 lesion showed significantly favorable prognoses as compared with the same stage patients who did not respond to the radiation therapy. However, the survival rates of the other pT stage patients did not correlate with the responsiveness to radiation. These results suggest that pT3 stage patients are the best candidates for preoperative radiation therapy, while radical cystectomy alone is adequate for those with superficially invasive lesions. Systemic chemotherapy should be properly built into the treatment strategy for those with locally far-advanced bladder cancer.
为提高局部浸润性膀胱癌患者的治愈率，自1980年以来，我们对88例患者在根治性膀胱切除术前行放射治疗。1984年以前，对46例患者的盆腔给予4周共40 Gy的照射，而自1985年以来，对42例患者给予2周24 Gy的照射，部分患者联合热疗。根据下村等1971年提出的评估系统，通过组织病理学评估治疗效果。约50%的患者对这种术前治疗反应良好。在这些患者中，与未对放射治疗产生反应的同阶段患者相比，pT3期病变患者的预后明显更好。然而，其他pT分期患者的生存率与对放射治疗的反应性无关。这些结果表明，pT3期患者是术前放射治疗的最佳候选者，而对于浅表浸润性病变患者，单纯根治性膀胱切除术就足够了。对于局部进展期膀胱癌患者，应在治疗策略中合理纳入全身化疗。
