Department of Urology, Tokyo Medical and Dental University Graduate School, Yushima, Tokyo 113-8519, Japan.
Jpn J Clin Oncol. 2011 Dec;41(12):1373-9. doi: 10.1093/jjco/hyr150. Epub 2011 Oct 11.
To compare rates of early morbidity after radical cystectomy in patients treated with or without induction chemoradiotherapy (CRT) using a standardized reporting methodology.
All 193 consecutive patients undergoing radical cystectomy for bladder cancer between 1989 and 2010 were retrospectively reviewed. Induction chemoradiotherapy consists of radiation at 40 Gy to the small pelvis and two cycles of concurrent cisplatin at 20 mg/day for 5 days. Deaths within 90 days after radical cystectomy and complications arising within 30 days were recorded and graded according to the Clavien-Dindo classification. Grades 1-2 were considered minor; Grades 3-5 were considered major.
Eighty-seven patients underwent radical cystectomy following chemoradiotherapy (chemoradiotherapy group) while the remaining 106 primarily underwent radical cystectomy (no chemoradiotherapy group). No Grade 4-5 complication was observed. Overall, 118 patients (61%) experienced 36 major and 122 minor complications. There was no significant difference in the incidence of overall complications between the chemoradiotherapy and no chemoradiotherapy groups (67 vs. 57%). Overall urinary anastomosis-related complications and major gastrointestinal complications, most of which were Grade 3 ileus, were more frequent in the chemoradiotherapy group than the no chemoradiotherapy group (11 vs. 2%, P = 0.007; and 14 vs. 4%, P = 0.02; respectively). Multivariate analysis identified induction chemoradiotherapy as an independent risk factor for overall urinary anastomosis-related complications (relative risk 6.0, P = 0.01) but not for major gastrointestinal complications.
Induction chemoradiotherapy at 40 Gy in bladder-sparing protocols against MIBC is unlikely to increase the rate of severe complications of radical cystectomy.
使用标准化报告方法比较接受或不接受诱导放化疗（CRT）的根治性膀胱切除术患者的早期发病率。
回顾性分析 1989 年至 2010 年间接受根治性膀胱切除术治疗的 193 例膀胱癌连续患者。诱导放化疗包括盆腔 40Gy 放疗和两个周期的顺铂同步治疗，每天 20mg，共 5 天。记录根治性膀胱切除术后 90 天内死亡和 30 天内出现的并发症，并根据 Clavien-Dindo 分类进行分级。1-2 级为轻度；3-5 级为重度。
87 例患者接受放化疗后行根治性膀胱切除术（放化疗组），其余 106 例患者主要行根治性膀胱切除术（未放化疗组）。未观察到 4-5 级并发症。总体而言，118 例患者（61%）发生 36 例严重和 122 例轻度并发症。放化疗组和未放化疗组的总体并发症发生率无显著差异（67%比 57%）。放化疗组与未放化疗组相比，整体尿吻合口相关并发症和主要胃肠道并发症更为常见，其中大多数为 3 级肠梗阻（11%比 2%，P=0.007；14%比 4%，P=0.02）。多变量分析确定诱导放化疗是整体尿吻合口相关并发症的独立危险因素（相对风险 6.0，P=0.01），但不是主要胃肠道并发症的危险因素。
在保膀胱的 MIBC 方案中，40Gy 诱导放化疗不太可能增加根治性膀胱切除术严重并发症的发生率。
