Feng Yin-Hsun, Shen Kun-Hung, Huang Kuan-Hua, Tzeng Wen-Sheng, Li Chien-Feng, Lin Kuei-Li
Division of Hematology and Oncology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Nursing, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan.
Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan; Department of Urology, Taipei Medical University, Taipei, Taiwan.
Clin Genitourin Cancer. 2016 Feb;14(1):e67-74. doi: 10.1016/j.clgc.2015.08.005. Epub 2015 Aug 29.
To investigate bladder preservation therapy with a well tolerated strategy, 30 patients with bladder cancer underwent concomitant chemoradiotherapy with weekly carboplatin. The 2-year overall survival was 75% for all patients, 43% and 95% for patients without adjuvant chemotherapy or with adjuvant chemotherapy separately. This strategy was well tolerated with 7% of Grade 3/4 late bladder toxicity.
The purpose of this study was to determine the feasibility and clinical effectiveness of concurrent weekly carboplatin chemotherapy in conjunction with definite radiation with or without adjuvant chemotherapy in the treatment of muscle-invasive bladder cancer.
Between April 2010 and December 2013, 30 patients with muscle-invasive bladder cancer were evaluated retrospectively in this study. Concurrent chemoradiotherapy (CCRT) with weekly carboplatin was initiated. CCRT was followed by 2 courses of carboplatin and gemcitabine limited to patients with Eastern Cooperative Oncology Group performance status < 3 and age < 80 years.
Thirty patients were treated and all completed the CCRT protocol. Seven of 8 patients (88%) achieved a pathological complete response (pCR) with CCRT alone, and 18 of 22 patients (82%) treated with CCRT followed by adjuvant chemotherapy had a pCR. The median follow-up was 23.2 (range, 8.3-40.7) months. The median progression-free survival was 15.9 months for the CCRT group, and not sufficient to evaluate CCRT followed by adjuvant chemotherapy. The median overall survival with CCRT was 18.8 months, and had not yet been reached for CCRT with adjuvant chemotherapy. The protocol was well tolerated for adverse events.
Our study has shown that concomitant chemotherapy using weekly carboplatin in the management of muscle-invasive bladder cancer is feasible and well tolerated, even in older patients. Additional adjuvant chemotherapy with 2 cycles of carboplatin and gemcitabine should be encouraged in physically fit patients. These results provide a basis for randomized studies to compare this approach with conventional therapy for patients who wish to preserve the bladder.
为研究一种耐受性良好的膀胱保留治疗策略，30例膀胱癌患者接受了每周一次卡铂的同步放化疗。所有患者的2年总生存率为75%，未接受辅助化疗或分别接受辅助化疗的患者的2年总生存率分别为43%和95%。该策略耐受性良好，3/4级晚期膀胱毒性发生率为7%。
本研究的目的是确定同步每周一次卡铂化疗联合确定性放疗加或不加辅助化疗治疗肌层浸润性膀胱癌的可行性和临床疗效。
2010年4月至2013年12月，本研究对30例肌层浸润性膀胱癌患者进行了回顾性评估。开始每周一次卡铂的同步放化疗（CCRT）。CCRT后，仅对东部肿瘤协作组体能状态<3且年龄<80岁的患者进行2个疗程的卡铂和吉西他滨治疗。
30例患者接受了治疗，均完成了CCRT方案。8例患者中有7例（88%）仅通过CCRT达到病理完全缓解（pCR），22例接受CCRT后辅助化疗的患者中有18例（82%）达到pCR。中位随访时间为23.2（范围8.3 - 40.7）个月。CCRT组的中位无进展生存期为15.9个月，CCRT后辅助化疗的情况因数据不足无法评估。CCRT的中位总生存期为18.8个月，CCRT联合辅助化疗的总生存期尚未达到。该方案对不良事件耐受性良好。
我们的研究表明，即使在老年患者中，使用每周一次卡铂的同步化疗治疗肌层浸润性膀胱癌也是可行的且耐受性良好。对于身体状况良好的患者，应鼓励额外进行2个周期卡铂和吉西他滨的辅助化疗。这些结果为将该方法与希望保留膀胱的患者的传统治疗方法进行比较的随机研究提供了依据。
