Gofrit Ofer N, Nof Rony, Meirovitz Amichai, Pode Dov, Frank Stephen, Katz Ran, Shapiro Amos, Landau Ezekiel H, Hidas Guy, Yutkin Vladimir, Duvdevani Mordechai, Wygoda Mark
Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Urol Oncol. 2015 Jan;33(1):19.e1-19.e5. doi: 10.1016/j.urolonc.2014.09.014. Epub 2014 Nov 4.
Muscle-invasive bladder cancer is most commonly treated by radical cystectomy. Patients who are too sick to go through this surgery or who are unwilling to accept the mutilation associated with it are referred to chemoradiation. We compared the results of these 2 modalities using age-matched populations.
Between 1998 and 2008, 33 patients were treated with chemoradiation for biopsy-proven T2-4aN0M0 urothelial bladder cancer. For every patient treated with chemoradiation, an age-matched patient who underwent radical cystectomy on the same year was selected for comparison. Mean radiotherapy dose was 62 Gy (standard deviation = 8.4) and median follow-up of both groups was approximately 36 months.
The groups were similar in age, proportion of men, and length of follow-up. However, the Charlson comorbidity index was significantly lower for operated patients (3.45 vs. 4.36, P = 0.01). Furthermore, 2 patients (6%) in the chemoradiation group had salvage cystectomy (one for disease recurrence and another for bladder shrinkage). The 2- and 5-year overall survival rates after surgery were 74.4% and 54.8%, respectively, and after chemoradiation were 70.2% and 56.6% (P = 0.8), respectively. The 2- and 5-year disease-free survival rates after surgery were 67.8% and 63.2%, respectively, and after chemoradiation were 63% and 54.3% (P = 0.89), respectively. Side effects were mild in both groups, with grade 3+toxicity seen in only 2 operated and 4 irradiated patients.
Despite having a significantly higher comorbidity index, patients treated with chemoradiation had similar overall and disease-free survival rates with low toxicity. Treatment with chemoradiation should be considered in patients with T2-4aN0M0 bladder cancer.
肌层浸润性膀胱癌最常用的治疗方法是根治性膀胱切除术。病情过重无法接受该手术或不愿接受与之相关的身体残缺的患者会接受放化疗。我们使用年龄匹配的人群比较了这两种治疗方式的结果。
1998年至2008年期间，33例经活检证实为T2-4aN0M0尿路上皮膀胱癌的患者接受了放化疗。对于每例接受放化疗的患者，选择同年接受根治性膀胱切除术的年龄匹配患者进行比较。平均放疗剂量为62 Gy（标准差=8.4），两组的中位随访时间约为36个月。
两组在年龄、男性比例和随访时间方面相似。然而，接受手术患者的查尔森合并症指数显著更低（3.45对4.36，P=0.01）。此外，放化疗组有2例患者（6%）接受了挽救性膀胱切除术（1例因疾病复发，另1例因膀胱萎缩）。手术后2年和5年的总生存率分别为74.4%和54.8%，放化疗后分别为70.2%和56.6%（P=0.8）。手术后2年和5年的无病生存率分别为67.8%和63.2%，放化疗后分别为63%和54.3%（P=0.89）。两组的副作用均较轻，仅2例接受手术和4例接受放疗的患者出现3级及以上毒性。
尽管合并症指数显著更高，但接受放化疗的患者的总生存率和无病生存率相似，毒性较低。对于T2-4aN0M0膀胱癌患者，应考虑放化疗。
