Pointreau Y, Klotz S, Denis F, Durdux C
Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan CHU de Tours, Hôpital Bretonneau, 2, Boulevard Tonnellé, 37000 Tours, France.
Cancer Radiother. 2010 Nov;14 Suppl 1:S189-97. doi: 10.1016/S1278-3218(10)70023-8.
Bladder cancer is an urologic common tumor after prostate carcinoma. Radical treatment of localized invasive tumor is based on cystectomy. Surgical mutilation could be important when Bricker's urinary derivation is performed. Moreover, delayed metastasis frequently appeared in spite of radical surgery. Thus, chemoradiotherapy is a valid alternative treatment to cystectomy for selected patients. Cisplatin or derivatives are usually concurrently administered to radiation therapy up to 60 - 65 Gy. Patients undergo control cystoscopy at midtime of treatment in order to select responders from non responders. For majority of cases, the empty bladder should be entirely treated with added margins (about 20 mm) to build the PTV. Control assessment could be improved by echography, cone beam imaging as well as bladder fiduciaries implantation before treatment. From a case report, this review summarizes the technical aspects of radiation therapy (GTV, CTV and PTV, organs at risk, planning) and main acute and late related toxicities.
膀胱癌是继前列腺癌之后泌尿外科常见的肿瘤。局限性浸润性肿瘤的根治性治疗以膀胱切除术为基础。当施行Bricker尿流改道术时,手术致残可能很严重。此外,尽管进行了根治性手术,仍经常出现延迟转移。因此,对于选定的患者,放化疗是膀胱切除术的一种有效的替代治疗方法。顺铂或其衍生物通常与高达60 - 65 Gy的放射治疗同时使用。患者在治疗中期接受膀胱镜检查,以便区分反应者和无反应者。对于大多数病例,应将空虚的膀胱全部进行治疗,并添加边缘(约20毫米)以构建计划靶体积(PTV)。治疗前通过超声检查、锥形束成像以及膀胱标志物植入可以改善对照评估。通过一个病例报告,本综述总结了放射治疗的技术方面(大体肿瘤体积、临床靶体积和计划靶体积、危及器官、计划)以及主要的急性和晚期相关毒性。