Pizzocaro G, Pisani E, Dormia E, Piva L, Maggioni A, Minervini G
Urological Oncology Division, Istituto Nazionale Tumori, Milano.
Prog Clin Biol Res. 1990;353:129-36.
Between July 1985 and December 1988, 31 consecutive patients with category T3b-T4a (NOMO) urothelial cancer of the urinary bladder were entered into a phase II study of neoadjuvant chemotherapy with medium-dose methotrexate (300 mg/m2 followed by folinic acid rescue), cisplatin (100 mg/m2 continuous i.v. infusion) every 4 weeks for a total of 4 courses. Six patients did not respond to the first two courses of neoadjuvant chemotherapy and another 3 were considered non-responders after 4 courses. Three of these 9 patients progressed and could not undergo salvage cystectomy. Only 4 patients (13%) entered complete remission, and one of them refused surgery. All the 18 (58%) partial responders underwent radical cystectomy. The overall 2-year disease-free survival is 72%: it is 100% for the 4 complete responders, 76% for the 18 partial responders and 56% for the 9 nonresponders. A longer follow-up is necessary to evaluate the impact of the neoadjuvant chemotherapy on survival of category T3b-T4a (NOMO) bladder cancer.
1985年7月至1988年12月期间，31例连续性膀胱尿路上皮癌T3b - T4a期（N0M0）患者进入一项新辅助化疗的II期研究，化疗方案为中剂量甲氨蝶呤（300 mg/m²，随后用亚叶酸解救）和顺铂（100 mg/m²持续静脉输注），每4周进行1个疗程，共4个疗程。6例患者对前两个疗程新辅助化疗无反应，另外3例在4个疗程后被视为无反应者。这9例患者中有3例病情进展，无法接受挽救性膀胱切除术。只有4例患者（13%）达到完全缓解，其中1例拒绝手术。所有18例（58%）部分缓解者均接受了根治性膀胱切除术。总体2年无病生存率为72%：4例完全缓解者为100%，18例部分缓解者为76%，9例无反应者为56%。需要更长时间的随访来评估新辅助化疗对T3b - T4a期（N0M0）膀胱癌患者生存的影响。
