Department of Radiation Oncology of Zhongshan hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, China.
BMC Cancer. 2011 Jul 14;11:297. doi: 10.1186/1471-2407-11-297.
Since transitional cell carcinoma (TCC) of the upper urinary tract is a relatively uncommon malignancy, the role of adjuvant radiotherapy is unknown.
We treated 133 patients with TCC of the renal pelvis or ureter at our institution between 1998 and 2008. The 67 patients who received external beam radiotherapy (EBRT) following surgery were assigned to the radiation group (RT). The clinical target volume included the renal fossa, the course of the ureter to the entire bladder, and the paracaval and para-aortic lymph nodes, which were at risk of harbouring metastatic disease in 53 patients. The tumour bed or residual tumour was targeted in 14 patients. The median radiation dose administered was 50 Gy. The 66 patients who received intravesical chemotherapy were assigned to the non-radiation group (non-RT).
The overall survival rates for the RT and non-RT groups were not significantly different (p = 0.198). However, there was a significant difference between the survival rates for these groups based on patients with T3/T4 stage cancer. A significant difference was observed in the bladder tumour relapse rate between the irradiated and non-irradiated bladder groups (p = 0.004). Multivariate analysis indicated that improved overall survival was associated with age < 60 years, T1 or T2 stage, absence of synchronous LN metastases, and EBRT. Acute gastrointestinal and bladder reactions were the most common symptoms, but mild non-severe (> grade 3) hematologic symptoms also occurred.
EBRT may improve overall survival for patients with T3/T4 cancer of the renal pelvis or ureter and delay bladder tumour recurrence in all patients.
由于上尿路移行细胞癌（TCC）是一种相对罕见的恶性肿瘤，辅助放疗的作用尚不清楚。
我们在我院治疗了 1998 年至 2008 年间的 133 例肾盂或输尿管 TCC 患者。术后接受外照射放疗（EBRT）的 67 例患者被分配到放射组（RT）。临床靶区包括肾窝、输尿管全程、腔静脉旁和腹主动脉旁淋巴结，53 例患者存在转移疾病的风险。14 例患者针对肿瘤床或残留肿瘤。中位放疗剂量为 50 Gy。接受膀胱内化疗的 66 例患者被分配到非放射组（非 RT）。
RT 组和非 RT 组的总生存率无显著差异（p = 0.198）。然而，T3/T4 期癌症患者的生存率存在显著差异。照射和未照射膀胱组的膀胱癌复发率存在显著差异（p = 0.004）。多因素分析表明，年龄<60 岁、T1 或 T2 期、无同步 LN 转移和 EBRT 与总生存率提高相关。急性胃肠道和膀胱反应是最常见的症状，但也有轻度非严重（>3 级）血液学症状。
EBRT 可能改善 T3/T4 期肾盂或输尿管癌患者的总生存率，并延迟所有患者的膀胱癌复发。
