Fan Kang-Hsing, Chen Yen-Chao, Leung Wei-Man, Chuang Cheng-Keng, Pang See-Tong, Hong Ji-Hong
Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Chang Gung Med J. 2012 May-Jun;35(3):247-54. doi: 10.4103/2319-4170.106147.
To investigate the role of radiotherapy (RT) for upper urinary tract urothelial cell carcinoma (UTUC) after surgery.
Between July 1997 and February 2007, 40 patients who had undergone radical surgery and RT were selected. Twenty patients received RT as adjuvant treatment for advanced disease (PORT). The remainder received RT as salvage treatment (SART). The prescription dose of RT ranged from 32 to 66.6 Gy (median: 50 Gy). Cisplatin-based chemotherapy was given to 34 patients. The median follow-up was 61 months (22-93 months).
At the time of analysis, 10 patients were alive, but two of them had tumor recurrence. Twenty-four patients died from disease recurrence, two died from chemotherapy-related complications, and two from non-cancer comorbidities. Two patients were lost to follow-up but one of them had tumor recurrence. The 3-year overall survival (OS) was 45% for the PORT group, and 16% for the SART group (p = 0.03). The 3-year progression-free survival (PFS) was 41% for the PORT group, and 12% for the SART group (p = 0.02). A prescription dose < 50 Gy (p = 0.02) was another poor prognostic factor. The 3-year OS was 38% for a prescription dose ≥ 50 Gy, and 18% for < 50 Gy (p = 0.06). The 3-year PFS improved from 7% to 41% if the prescribed dose was ≥ 50 Gy (p < 0.05).
According to our analysis, RT combined with chemotherapy is effective in the postoperative treatment of advanced disease and salvage treatment for recurrent UTUC. The prescription dose should be ≥ 50 Gy.
探讨放疗（RT）在手术治疗上尿路尿路上皮癌（UTUC）后的作用。
选取1997年7月至2007年2月期间40例行根治性手术及放疗的患者。20例患者接受放疗作为晚期疾病的辅助治疗（PORT）。其余患者接受放疗作为挽救性治疗（SART）。放疗的处方剂量为32至66.6 Gy（中位数：50 Gy）。34例患者接受了以顺铂为基础的化疗。中位随访时间为61个月（22 - 93个月）。
分析时，10例患者存活，但其中2例有肿瘤复发。24例患者死于疾病复发，2例死于化疗相关并发症，2例死于非癌症合并症。2例患者失访，但其中1例有肿瘤复发。PORT组的3年总生存率（OS）为45%，SART组为16%（p = 0.03）。PORT组的3年无进展生存率（PFS）为41%，SART组为12%（p = 0.02）。处方剂量<50 Gy（p = 0.02）是另一个不良预后因素。处方剂量≥50 Gy时3年OS为38%，<50 Gy时为18%（p = 0.06）。如果处方剂量≥50 Gy，3年PFS从7%提高到41%（p < 0.05）。
根据我们的分析，放疗联合化疗在晚期疾病的术后治疗及复发性UTUC的挽救性治疗中有效。处方剂量应≥50 Gy。
