Efstathiou Jason A, Bae Kyounghwa, Shipley William U, Kaufman Donald S, Hagan Michael P, Heney Niall M, Sandler Howard M
Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom St, Cox 3, Boston, MA 02114, USA.
J Clin Oncol. 2009 Sep 1;27(25):4055-61. doi: 10.1200/JCO.2008.19.5776. Epub 2009 Jul 27.
In selected patients with muscle-invasive bladder cancer, combined-modality therapy (transurethral resection bladder tumor [TURBT], radiation therapy, chemotherapy) with salvage cystectomy, if necessary, can achieve survival rates similar to radical cystectomy. We investigated late pelvic toxicity after chemoradiotherapy for patients treated on prospective protocols.
Between 1990 and 2002, 285 eligible patients enrolled on four prospective protocols (Radiation Therapy Oncology Group [RTOG] 8903, 9506, 9706, 9906) and 157 underwent combined-modality therapy, surviving >or= 2 years from start of treatment with their bladder intact. Rates of late genitourinary (GU) and GI toxicity were assessed using the RTOG Late Radiation Morbidity Schema, with worst toxicity grade (scale 0 to 5) occurring >or= 180 days after start of consolidation therapy reported for each patient. Persistence of toxicity was defined as grade 3+ toxicity not decreasing by at least one grade. Logistic and Cox regression analyses were performed to evaluate relationship between clinical characteristics, frequency, and time to late grade 3+ pelvic toxicity. Covariates included age, sex, stage, presence of carcinoma in situ, completeness of TURBT, and protocol.
Median follow-up was 5.4 years (range, 2.0 to 13.2 years). Seven percent of patients experienced late grade 3+ pelvic toxicity: 5.7% GU and 1.9% GI. In only one of nine patients did a grade 3+ GU toxicity persist. Notably there were no late grade 4 toxicities and no treatment-related deaths. None of the clinical variables studied predicted for late grade 3+ pelvic toxicity.
Rates of significant late pelvic toxicity for patients completing combined-modality therapy for invasive bladder cancer and retaining their native bladder are low.
对于部分肌肉浸润性膀胱癌患者，联合治疗（经尿道膀胱肿瘤切除术[TURBT]、放射治疗、化疗）必要时行挽救性膀胱切除术，可获得与根治性膀胱切除术相似的生存率。我们对接受前瞻性方案治疗的患者进行放化疗后的晚期盆腔毒性进行了研究。
1990年至2002年间，285例符合条件的患者纳入四项前瞻性方案（放射治疗肿瘤学组[RTOG]8903、9506、9706、9906），157例接受联合治疗，自治疗开始后膀胱完整存活≥2年。使用RTOG晚期放射病发病模式评估晚期泌尿生殖系统（GU）和胃肠道（GI）毒性发生率，报告每位患者巩固治疗开始≥180天后出现的最严重毒性等级（0至5级）。毒性持续存在定义为3级及以上毒性未降低至少一个等级。进行逻辑回归和Cox回归分析，以评估临床特征、频率与晚期3级及以上盆腔毒性发生时间之间的关系。协变量包括年龄、性别、分期、原位癌的存在、TURBT的完整性和方案。
中位随访时间为5.4年（范围2.0至13.2年）。7%的患者出现晚期3级及以上盆腔毒性：5.7%为GU毒性，1.9%为GI毒性。9例患者中仅1例3级及以上GU毒性持续存在。值得注意的是，没有晚期4级毒性，也没有与治疗相关的死亡。所研究的临床变量均未预测晚期3级及以上盆腔毒性。
完成浸润性膀胱癌联合治疗并保留其天然膀胱的患者，严重晚期盆腔毒性发生率较低。
