Orré Mathieu, Latorzeff Igor, Fléchon Aude, Roubaud Guilhem, Brouste Véronique, Gaston Richard, Piéchaud Thierry, Richaud Pierre, Chapet Olivier, Sargos Paul
Department of Radiotherapy, Institut Bergonié, Bordeaux,France.
Department of Radiotherapy, Groupe Oncorad Garonne, Clinique Pasteur, Toulouse, France.
PLoS One. 2017 Apr 6;12(4):e0174978. doi: 10.1371/journal.pone.0174978. eCollection 2017.
Radical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We evaluate 3-year LRR-free (LRRFS), metastasis-free (MFS) and overall survivals (OS) after adjuvant radiotherapy (RT) for pathological high-risk MIBC.
We retrospectively reviewed data from patients in 3 institutions. Inclusion criteria were MIBC, histologically-proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. Outcomes were evaluated by Kaplan-Meier method. Acute toxicities were recorded according to CTCAE V4.0 scale.
Between 2000 and 2013, 57 patients [median age 66.3 years (45-84)] were included. Post-operative pathological staging was ≤pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% pN0, 26% pN1 and 42% pN2. Median number of lymph-nodes retrieved was 10 (2-33). Forty-eight patients (84%) received platin-based chemotherapy. For RT, clinical target volume 1 (CTV 1) encompassed pelvic lymph nodes for all patients. CTV 1 also included cystectomy bed for 37 patients (65%). CTV 1 median dose was 45 Gy (4-50). A boost of 16 Gy (5-22), corresponding to CTV 2, was administered for 30 patients, depending on pathological features. One third of patients received intensity-modulated RT. With median follow-up of 40.4 months, 8 patients (14%) had LRR. Three-year LRRFS, MFS and OS were 45% (95%CI 30-60), 37% (95%CI 24-51) and 49% (95%CI 33-63), respectively. Five (9%) patients had acute grade ≥3 toxicities (gastro-intestinal, genito-urinary and biological parameters). One patient died with intestinal fistula in a septic context.
Because of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. Adjuvant RT is feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.
根治性膀胱切除术（RC）和盆腔淋巴结清扫术（LND）是非转移性肌层浸润性尿路上皮膀胱癌（MIBC）的标准治疗方法。然而，局部区域复发（LRR）是一种常见的早期事件，与预后不良相关。我们评估了病理高危MIBC辅助放疗（RT）后的3年无局部区域复发生存率（LRRFS）、无转移生存率（MFS）和总生存率（OS）。
我们回顾性分析了3家机构患者的数据。纳入标准为MIBC、经组织学证实的尿路上皮癌且接受了RC和辅助RT治疗。排除接受保守手术的患者。采用Kaplan-Meier法评估预后。根据CTCAE V4.0标准记录急性毒性反应。
2000年至2013年期间，纳入了57例患者[中位年龄66.3岁（45 - 84岁）]。术后病理分期≤pT2、pT3和pT4的患者分别占16%、44%和39%。盆腔淋巴结清扫显示28%为pN0、26%为pN1和42%为pN2。中位切除淋巴结数为10个（2 - 33个）。48例患者（84%）接受了铂类化疗。对于放疗，所有患者的临床靶区1（CTV 1）包括盆腔淋巴结。37例患者（65%）的CTV 1还包括膀胱切除床。CTV 1的中位剂量为45 Gy（4 - 50）。根据病理特征，30例患者接受了相当于CTV 2的16 Gy（5 - 22）的追加剂量照射。三分之一的患者接受了调强放疗。中位随访40.4个月，8例患者（14%）发生LRR。3年LRRFS、MFS和OS分别为45%（95%CI：30 - 60）、37%（95%CI：24 - 51）和49%（95%CI：33 - 63）。5例（9%）患者出现急性3级及以上毒性反应（胃肠道、泌尿生殖系统和生物学参数）。1例患者因肠瘘在脓毒症情况下死亡。
由于预后不良，病理高危MIBC需要有效的术后标准治疗方案。辅助放疗是可行且可能具有肿瘤学益处。应开展前瞻性试验，采用当前放疗技术评估这种方法。
Zotero 插件