Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
J Formos Med Assoc. 2017 Sep;116(9):689-696. doi: 10.1016/j.jfma.2016.10.014. Epub 2016 Dec 26.
BACKGROUND/PURPOSE: To retrospectively evaluate the failure patterns of multimodality bladder-preserving therapy in patients with muscle-invasive bladder cancer.
Patients with muscle-invasive bladder cancer underwent maximal transurethral resection of bladder tumor and induction chemotherapy, followed by concurrent chemoradiotherapy (CCRT). Radiotherapy was given with 45 Gy to the pelvis, 50.4 Gy to the bladder, and 64.8 Gy to the tumor bed. Three protocols of trimodality treatment were used: Protocol A, three cycles of cisplatin and fluorouracil (CF), followed by CCRT with 6 weekly cisplatin; Protocol B, three cycles of weekly paclitaxel plus CF, followed by CCRT with 6 weekly paclitaxel and cisplatin; Protocol C, three cycles of gemcitabine and cisplatin, followed by CCRT with 6 weekly cisplatin. Interval cystoscopy confirmed complete response (CR) after induction chemotherapy and 40-50 Gy of radiotherapy. Patients without CR were referred for salvage cystectomy.
A total of 60 patients were enrolled, including 11 patients with unfavorable factors defined as hydronephrosis and/or pelvic nodal involvement. After a median follow-up of 86.7 months, the 5-year overall, progression-free, and bladder preservation-specific survival rates were 76.3%, 62.9%, and 71.5%, respectively. Three patients underwent salvage cystectomy for invasive bladder recurrence. Of 45 surviving patients, 42 patients (93.3%) retained functioning bladders. Patients with unfavorable factors had significantly lower metastasis-free survival (p=0.002), but not bladder preservation-specific survival (p=0.25).
With trimodality treatment involving visually complete transurethral resection of bladder tumor, cisplatin-based induction chemotherapy, and CCRT, patients with unfavorable factors maintained satisfactory bladder preservation but not systemic control.
背景/目的：回顾性评估多模式膀胱保留治疗肌层浸润性膀胱癌患者的失败模式。
肌层浸润性膀胱癌患者接受最大经尿道膀胱肿瘤切除术和诱导化疗，随后进行同期放化疗（CCRT）。盆腔给予 45Gy、膀胱给予 50.4Gy、肿瘤床给予 64.8Gy 放疗。使用三种三联治疗方案：方案 A，顺铂和氟尿嘧啶（CF）三个周期，随后给予 6 个周期顺铂的 CCRT；方案 B，每周紫杉醇加 CF 三个周期，随后给予 6 个周期每周紫杉醇和顺铂的 CCRT；方案 C，吉西他滨和顺铂三个周期，随后给予 6 个周期顺铂的 CCRT。间隔膀胱镜检查确认诱导化疗和 40-50Gy 放疗后完全缓解（CR）。未达到 CR 的患者被转诊行挽救性膀胱切除术。
共纳入 60 例患者，其中 11 例患者存在肾积水和/或盆腔淋巴结受累等不利因素。中位随访 86.7 个月后，5 年总生存率、无进展生存率和膀胱保留特异性生存率分别为 76.3%、62.9%和 71.5%。3 例患者因膀胱癌浸润性复发而行挽救性膀胱切除术。45 例存活患者中，42 例（93.3%）保留了功能膀胱。有不利因素的患者无远处转移生存率显著降低（p=0.002），但膀胱保留特异性生存率无差异（p=0.25）。
对于有不利因素的患者，采用包括完全经尿道膀胱肿瘤切除术、顺铂为基础的诱导化疗和 CCRT 的三联治疗方法，能够获得令人满意的膀胱保留效果，但不能获得全身控制效果。
