McPherson Victor A, Rodrigues George, Bauman Glenn, Winquist Eric, Chin Joseph, Izawa Jonathan, Potvin Kylea, Ernst Scott, Venkatesan Varagur, Sexton Tracy, Ahmad Belal, Power Nicholas
Division of Urology.
Division of Radiation Oncology.
Can Urol Assoc J. 2017 Jan-Feb;11(1-2):24-30. doi: 10.5489/cuaj.4008.
While radical cystectomy is the gold standard for muscle-invasive bladder cancer (MIBC), in octogenarians cystectomy results in a higher perioperative mortality rate (6.8-11.1%) than in younger patients (2.2%). Trimodality therapy is a bladder-sparing regimen composed of transurethral resection of bladder tumour (TURBT) and chemoradiotherapy, with intent for salvage cystectomy, and has a 62.5-90% initial complete response rate. In this study, we evaluate TURBT and chemoradiotherapy without salvage cystectomy in medically inoperable octogenarian patients.
We identified a retrospective cohort of patients aged 80-89 years with invasive urothelial carcinoma who received combination chemoradiotherapy between 2008 and June 2014. Outcomes were evaluated by Kaplan-Meier (KM) and Cox regression.
In 40 patients, the mean age was 84.5 years (interquartile range [IQR] 83-86). Seventeen patients received hypofractionated, low-dose radiotherapy (LD) (37.5-40 Gy), while 23 received conventionally fractionated radiotherapy (high-dose [HD]) (50-65 Gy). Mean overall survival (OS) was 20.7 months (IQR 12.75-23.25), while mean recurrence-free survival (RFS) was 13.75 months (IQR 3.75-16.5). Patients receiving HD radiotherapy showed improved OS and local RFS (LRFS) without significant differences in Grade 3-4 toxicities. Univariate Cox regression identified hydronephrosis as a predictor of worse OS and local recurrence and HD radiotherapy as a predictor of improved OS and local recurrence rates. Multivariate Cox regression identified hydronephrosis to be a significant predictor of LRFS.
Primary chemoradiotherapy for inoperable patients with MIBC resulted in a three-year OS of 54.9% (comparable to cystectomy) and three-year RFS of 42.3%. Superior outcomes were associated with more aggressive chemoradiotherapy treatment. The results of the local control subanalyses in this study are hypothesis-generating due to the limited patient numbers in the cohort.
虽然根治性膀胱切除术是肌层浸润性膀胱癌（MIBC）的金标准，但在八十多岁的患者中，膀胱切除术导致的围手术期死亡率（6.8 - 11.1%）高于年轻患者（2.2%）。三联疗法是一种保留膀胱的治疗方案，由经尿道膀胱肿瘤切除术（TURBT）和放化疗组成，目的是挽救性膀胱切除术，初始完全缓解率为62.5 - 90%。在本研究中，我们评估了在医学上无法进行手术的八十多岁患者中不进行挽救性膀胱切除术的TURBT和放化疗。
我们确定了一个回顾性队列，其中包括2008年至2014年6月期间接受联合放化疗的80 - 89岁浸润性尿路上皮癌患者。通过Kaplan-Meier（KM）法和Cox回归评估结果。
40例患者的平均年龄为84.5岁（四分位间距[IQR] 83 - 86）。17例患者接受了大分割低剂量放疗（LD）（37.5 - 40 Gy），而23例接受了常规分割放疗（高剂量[HD]）（50 - 65 Gy）。平均总生存期（OS）为20.7个月（IQR 12.75 - 23.25），平均无复发生存期（RFS）为13.75个月（IQR 3.75 - 16.5）。接受HD放疗的患者OS和局部无复发生存期（LRFS）有所改善，3 - 4级毒性无显著差异。单因素Cox回归确定肾积水是OS和局部复发较差的预测因素，HD放疗是OS和局部复发率改善的预测因素。多因素Cox回归确定肾积水是LRFS的重要预测因素。
对无法手术的MIBC患者进行的初始放化疗导致三年OS为54.9%（与膀胱切除术相当），三年RFS为42.3%。更好的结果与更积极的放化疗治疗相关。由于队列中的患者数量有限本研究局部控制亚分析的结果仅用于产生假设。
