Hafeez S, Horwich A, Omar O, Mohammed K, Thompson A, Kumar P, Khoo V, Van As N, Eeles R, Dearnaley D, Huddart R
1] The Royal Marsden NHS Foundation Trust, London, UK [2] The Institute of Cancer Research, London, UK.
The Royal Marsden NHS Foundation Trust, London, UK.
Br J Cancer. 2015 May 12;112(10):1626-35. doi: 10.1038/bjc.2015.109. Epub 2015 Apr 21.
Radiotherapy for muscle invasive bladder cancer (MIBC) aims to offer organ preservation without oncological compromise. Neo-adjuvant chemotherapy provides survival advantage; response may guide patient selection for bladder preservation and identify those most likely to have favourable result with radiotherapy.
Ninety-four successive patients with T2-T4aN0M0 bladder cancer treated between January 2000 and June 2011 were analysed at the Royal Marsden Hospital. Patients received platinum-based chemotherapy following transurethral resection of bladder tumour; repeat cystoscopy (± biopsy) was performed to guide subsequent management. Responders were treated with radiotherapy. Poor responders were recommended radical cystectomy. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method; univariate and multivariate analyses were performed using the Cox proportional hazard regression model.
Response assessment was performed in 89 patients. Seventy-eight (88%) demonstrated response; 53 (60%) achieved complete response (CR); 74 responders had radiotherapy; 4 opted for cystectomy. Eleven (12%) demonstrated poor response, 10 received cystectomy. Median survival for CR was 90 months (95% CI 64.7, 115.9) compared with 16 months (95% CI 5.4, 27.4; P < 0.001) poor responders. On multivariate analysis, only response was associated with significantly improved PFS, OS and DSS. After a median follow-up of 39 months (range 4-127 months), 14 patients (16%) required salvage cystectomy (8 for non-muscle invasive disease, 5 for invasive recurrence, 1 for radiotherapy related toxicity). In all, 82% had an intact bladder at last follow-up after radiotherapy; 67% had an intact bladder at last follow-up or death. Our study is limited by its retrospective nature.
Response to neo-adjuvant chemotherapy is a favourable prognostic indicator and can be used to select patients for radiotherapy allowing bladder preservation in >80% of the selected patients.
肌肉浸润性膀胱癌（MIBC）的放射治疗旨在在不影响肿瘤学疗效的前提下实现器官保留。新辅助化疗可带来生存获益；化疗反应可指导患者选择膀胱保留治疗，并识别出那些最有可能从放射治疗中获得良好疗效的患者。
对2000年1月至2011年6月期间在皇家马斯登医院接受治疗的94例连续的T2-T4aN0M0期膀胱癌患者进行分析。患者在经尿道膀胱肿瘤切除术后接受铂类化疗；进行重复膀胱镜检查（±活检）以指导后续治疗。化疗有反应者接受放射治疗。化疗反应差者建议行根治性膀胱切除术。采用Kaplan-Meier法估计无进展生存期（PFS）、疾病特异性生存期（DSS）和总生存期（OS）；使用Cox比例风险回归模型进行单因素和多因素分析。
对89例患者进行了反应评估。78例（88%）有反应；53例（60%）达到完全缓解（CR）；74例有反应者接受了放射治疗；4例选择了膀胱切除术。11例（12%）反应差，10例接受了膀胱切除术。CR患者的中位生存期为90个月（95%CI 64.7，115.9），而反应差者为16个月（95%CI 5.4，27.4；P<0.001）。多因素分析显示，只有化疗反应与PFS、OS和DSS的显著改善相关。中位随访39个月（范围4-127个月）后，14例患者（16%）需要挽救性膀胱切除术（8例为非肌肉浸润性疾病，5例为浸润性复发，1例为放疗相关毒性）。总体而言，82%的患者在放疗后的最后一次随访时膀胱完整；67%的患者在最后一次随访或死亡时膀胱完整。本研究受其回顾性研究性质的限制。
新辅助化疗的反应是一个良好的预后指标，可用于选择接受放射治疗的患者，使80%以上的选定患者能够保留膀胱。
