Song Yi-Peng, Ma Jin-Bo, Wang Lin, Chen Er-Cheng, Liu Peng, Ma Zhao, Zang Ru-Kun, Yu Jin-Ming
Department of Oncology, Tianjin Medical University, Tianjin, China.
Department of Radiation Oncology, Yantai Yuhuangding Hospital, School of Medicine, Qingdao University, Yantai, China.
Asia Pac J Clin Oncol. 2017 Apr;13(2):e111-e116. doi: 10.1111/ajco.12351. Epub 2015 Apr 14.
To evaluate the efficacy and safety of late-course hypofractionated radiation treatment of muscle-invasive bladder carcinoma after bladder-conserving surgery.
Seventy-six patients with transitional cell bladder carcinoma, stage II (T2-4N0M0), after transurethral resection, were enrolled. Pirarubicin was given at 30 mg/m and 100 mL physiological saline once weekly (QW) for 12 weeks through and after intravesical instillation postoperatively. Radiation schedule delivered 46 Gy in 20 fractions for planning target volume, with an additional 20 Gy in five fractions for gross tumor volume as late-course radiation. Chemotherapy was stopped if Radiation Therapy Oncology Group grade 3 or higher bladder or bowel toxicity occurred. The primary end points were acute toxicity, local control and patients' survival.
One-, three- and five-year overall survival rates were 98, 78 and 69.5%, respectively. Mean survival time was 58.4 months (95% CI: 52.6, 64.2). In addition, 1-, 3- and 5-year local control rates were 100, 80.5 and 76.1%, respectively. Mean local control time was 60.7 months (95% CI: 55.1, 66.3). The cumulative incidence of local/regional failure and distant failure was 28.9%. The rate of single local/regional failure was 13.2%, but distant failure rate was 21.1%.
Concurrent pirarubicin-based late-course hypofractionated radiation therapy showed desirable local control rate and acceptable toxicity. It could be used after bladder-conserving surgery to allow patients to preserve their bladder.
评估保膀胱手术后晚期超分割放射治疗肌层浸润性膀胱癌的疗效和安全性。
纳入76例经尿道切除术后的Ⅱ期（T2-4N0M0）移行细胞膀胱癌患者。术后膀胱灌注吡柔比星，剂量为30mg/m²，溶于100mL生理盐水中，每周一次，共12周。放疗计划为针对计划靶区给予46Gy分20次照射，针对大体肿瘤体积额外给予20Gy分5次照射作为晚期放疗。如果出现放射肿瘤学组3级或更高等级的膀胱或肠道毒性，则停止化疗。主要终点为急性毒性、局部控制率和患者生存率。
1年、3年和5年总生存率分别为98%、78%和69.5%。平均生存时间为58.4个月（95%可信区间：52.6，64.2）。此外，1年、3年和5年局部控制率分别为100%、80.5%和76.1%。平均局部控制时间为60.7个月（95%可信区间：55.1，66.3）。局部/区域失败和远处失败的累积发生率为28.9%。单纯局部/区域失败率为13.2%，但远处失败率为21.1%。
基于吡柔比星的同期晚期超分割放射治疗显示出理想的局部控制率和可接受的毒性。可用于保膀胱手术后，使患者能够保留膀胱。
