Radiation Oncology Department, Children's Cancer Hospital (57357), Egypt & National Cancer Institute, Cairo University, 1 Sekket El Emam, Sayeda Zainab, Cairo, Egypt.
Future Oncol. 2010 Jul;6(7):1177-91. doi: 10.2217/fon.10.82.
To date, radical cystectomy has continued to be the treatment of choice for muscle-invasive bladder cancer. It is associated with a 5-year disease-free survival rate ranging from 27-55%. This outcome is significantly worse when reporting upon locally advanced cases. The independent prognostic factors include: tumor stage, grade, pelvic nodal involvement and some other additional factors. Beside the higher reported incidence of distant metastasis, local recurrence either alone or combined with systemic relapse has been shown to be experienced by 23-50% of locally advanced patients - a rate that was much more frequent than previously believed. Nonrandomized trials of preoperative radiotherapy have suggested improved survival rates. However, only one out of the six randomized preoperative trials in the literature published in English has proved to be significant. On the other hand, the only randomized trial and most retrospective studies dealing with postoperative radiotherapy revealed a significant increase in disease-free survival. Late complications of post operative radiotherapy, contrary to former belief, were acceptable and generally depended upon the volume of the irradiated normal tissues and the radiotherapy techniques used. Most of these adjuvant or neoadjuvant reports were performed in the 1970s and 1980s using conventional radiation techniques. Modern radiotherapy, delivering higher doses to the tumor while saving a significant amount of the surrounding normal structure, has not been rigorously tested. However, these techniques have already succeeded in improving treatment end results in other pelvic tumors.
迄今为止，根治性膀胱切除术仍然是肌层浸润性膀胱癌的治疗选择。它的 5 年无病生存率为 27%至 55%。当报告局部进展病例时，结果明显更差。独立的预后因素包括：肿瘤分期、分级、盆腔淋巴结受累和其他一些附加因素。除了远处转移的发病率较高外，局部复发（单独或与全身复发结合）已被证明发生在 23%至 50%的局部进展患者中——这一比率比以前认为的要高得多。术前放疗的非随机试验表明生存率有所提高。然而，在已发表的六篇英文随机术前试验中，只有一篇证明具有显著意义。另一方面，唯一的随机试验和大多数涉及术后放疗的回顾性研究都显示出无病生存率的显著提高。与以前的观点相反，术后放疗的晚期并发症是可以接受的，并且通常取决于受照射的正常组织的体积和使用的放疗技术。这些辅助或新辅助报告大多是在 20 世纪 70 年代和 80 年代使用常规放疗技术进行的。现代放疗在向肿瘤提供更高剂量的同时，还能显著保护周围正常组织，尚未经过严格测试。然而，这些技术已经成功地改善了其他盆腔肿瘤的治疗结果。
