Khader Jamal, Farah Naim, Salem Ahmed
Department of Radiation Oncology, King Hussein Cancer Center, HM Queen Rania Street, P.O. Box 1269, Amman 11941, Jordan.
Department of Surgical Oncology, Division of Urology, King Hussein Cancer Center, HM Queen Rania Street, P.O. Box 1269, Amman 11941, Amman, Jordan.
Rep Pract Oncol Radiother. 2011 May 23;16(5):178-83. doi: 10.1016/j.rpor.2011.04.003. eCollection 2011.
Radical cystectomy is the standard treatment for patients with muscle-invasive urinary bladder cancer; however, is associated with major treatment - related morbidity. Furthermore, a significant proportion of patients are deemed unsuitable for surgery due to inoperability, advanced age, and/or comorbid conditions. As such, several groups have explored effectiveness of less radical therapeutic strategies that aim at bladder preservation. Nonetheless, there is scarcity of reports assessing the applicability of urinary bladder-sparing outside developed countries.
Determine the achievable outcomes for patients with muscle-invasive urinary bladder cancer treated via bladder-sparing techniques in a low income country.
Fourteen consecutive patients with a diagnosis of muscle-invasive urinary bladder cancer (clinical stage; T2-3N0M0) were treated via a bladder-sparing approach at King Hussein Cancer Center (Amman, Jordan) between 2005 and 2009. Records were electronically retrieved and retrospectively analyzed and included 11 males and 3 females from 41 to 74 years of age (median age, 61). Initial therapy consisted of trans-urethral resection of bladder tumor (TURBT) followed by induction chemotherapy then irradiation (4500cGy) with concurrent platinum-based chemotherapy. Urological evaluation directed additional therapy in a proportion of patients with irradiation (up to 6400 cGy) in patients who achieved CR.
Eleven patients were evaluable for pathological response at time of re-staging; of whom 8 (73%) achieved CR and 3 (27%) achieved partial response (PR). In all but one patient; combined-modality treatment was well tolerated. After a median follow-up of 18.5 months (range, 3-48 months); 5 of 8 (62.5%) patients with CR were alive.
Bladder-sparing strategies via concurrent chemoradiation for muscle-invasive bladder cancer results in an acceptable rate of complete pathological response with adequate short-term outcomes. This approach appears applicable in low-income countries.
根治性膀胱切除术是肌层浸润性膀胱癌患者的标准治疗方法；然而，它与主要的治疗相关并发症有关。此外，相当一部分患者由于无法手术、高龄和/或合并症而被认为不适合手术。因此，一些研究小组探索了旨在保留膀胱的不太激进的治疗策略的有效性。尽管如此，在发达国家以外，评估膀胱保留疗法适用性的报告却很少。
确定在低收入国家通过膀胱保留技术治疗的肌层浸润性膀胱癌患者可实现的治疗效果。
2005年至2009年期间，在侯赛因国王癌症中心（约旦安曼），对14例连续诊断为肌层浸润性膀胱癌（临床分期；T2-3N0M0）的患者采用膀胱保留方法进行治疗。通过电子检索记录并进行回顾性分析，其中包括11名男性和3名女性，年龄在41至74岁之间（中位年龄61岁）。初始治疗包括经尿道膀胱肿瘤切除术（TURBT），然后进行诱导化疗，接着进行放疗（4500cGy）并同时进行铂类化疗。泌尿外科评估指导对部分放疗患者（剂量可达6400cGy）进行额外治疗，这些患者达到了完全缓解（CR）。
11例患者在重新分期时可评估病理反应；其中8例（73%）达到CR，3例（27%）达到部分缓解（PR）。除1例患者外，所有患者对联合治疗耐受性良好。中位随访18.5个月（范围3-48个月）后，8例CR患者中有5例（62.5%）存活。
对于肌层浸润性膀胱癌，通过同步放化疗的膀胱保留策略可产生可接受的完全病理缓解率，并具有良好的短期治疗效果。这种方法似乎适用于低收入国家。
