Régnier É, Nguyen T D, Beckendorf V, Lagrange J-L
Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France.
Cancer Radiother. 2013 Oct;17(5-6):470-6. doi: 10.1016/j.canrad.2013.06.024. Epub 2013 Aug 19.
Radical cystectomy is the gold standard treatment of invasive bladder carcinoma, but conservative treatment is a serious option for selected patients. It comprises a transurethral resection, as complete as possible, before a radiation therapy of the whole bladder and pelvis, with a concomitant chemotherapy. Bladder wall movements during the treatment course lead to the use of wide margins to cover the clinical target volume. Planning target volume margins must be anisotropic to correspond to the mobility of each bladder zone: 10mm in the inferior portion, 15 mm in lateral directions, and 20 to 25 mm in anterior and superior directions. The development of image-guided radiotherapy and adaptative radiotherapy should lead to a reduction of these margins. Besides, partial bladder radiotherapy is showing encouraging results, by reducing the clinical target volume in well-selected patients.
根治性膀胱切除术是浸润性膀胱癌的金标准治疗方法，但对于特定患者，保守治疗也是一种重要选择。它包括在对整个膀胱和盆腔进行放射治疗之前，尽可能完整地经尿道切除术，并同时进行化疗。治疗过程中膀胱壁的移动导致需要使用较宽的边界来覆盖临床靶区。计划靶区边界必须是各向异性的，以对应每个膀胱区域的移动性：下部为10毫米，侧面为15毫米，前后和上部为20至25毫米。图像引导放疗和自适应放疗的发展应能减少这些边界。此外，部分膀胱放疗在精心挑选的患者中通过减少临床靶区显示出令人鼓舞的结果。
