新辅助化疗在非转移性肌层浸润性膀胱癌患者膀胱保留放化疗前的应用。
Neoadjuvant Chemotherapy Before Bladder-Sparing Chemoradiotherapy in Patients With Nonmetastatic Muscle-Invasive Bladder Cancer.
机构信息
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada.
出版信息
Clin Genitourin Cancer. 2019 Feb;17(1):38-45. doi: 10.1016/j.clgc.2018.09.021. Epub 2018 Oct 4.
BACKGROUND
Cisplatin-based neoadjuvant chemotherapy (NAC) before cystectomy improves survival in muscle-invasive urothelial bladder cancer (MIBC). The use of NAC before chemoradiation (CRT) has been limited, as these patients are often elderly, frail, and ineligible for cisplatin. However, the role of NAC in fit, cisplatin-eligible patients who opt for bladder preservation warrants further evaluation.
PATIENTS AND METHODS
Patients with MIBC treated with NAC followed by CRT at the Princess Margaret and Durham Regional cancer centers from 2008 to 2017 were retrospectively reviewed. Gemcitabine-cisplatin NAC was given for 2 to 4 cycles, followed by reassessment for CRT. External-beam radiotherapy (60-66 Gy) over 6 weeks was given with concurrent weekly cisplatin at 40 mg/m. Kaplan-Meier method was used for survival analyses.
RESULTS
We identified 57 consecutive patients. Median age was 72 (range 45-87), and all had an Eastern Cooperative Oncology Group performance status of 0 (60%) or 1 (40%). Stage II disease (65%), stage III disease (25%), and regional nodal metastases (11%) were included. Most completed planned NAC (95%). All patients completed external-beam radiotherapy, and 84% completed at least 60% of the planned concurrent weekly cisplatin doses. Median (range) follow-up was 19.3 (4.8-96.1) months. Median overall survival (OS) was not reached. Two-year OS and disease-specific survival rates were 74% (95% confidence interval, 57.7-84.9) and 88% (95% confidence interval, 78.5-98.1), respectively. Two-year bladder-intact disease-free survival was 64%. Salvage cystectomy was performed in 14%. Distant relapse occurred in 11%, and 9% died of metastatic disease. OS was associated with baseline hydronephrosis and with bladder-intact disease-free survival with residual disease on cystoscopy.
CONCLUSION
NAC followed by CRT can result in encouraging outcomes and tolerability in cisplatin-eligible patients.
背景
顺铂为基础的新辅助化疗（NAC）在接受膀胱切除术之前可提高肌层浸润性膀胱癌（MIBC）患者的生存率。由于这些患者通常年龄较大、身体虚弱且不符合顺铂治疗标准，因此在接受放化疗（CRT）之前使用 NAC 的情况有限。然而，对于选择保留膀胱的、符合条件且接受顺铂治疗的患者，NAC 的作用需要进一步评估。
方法
回顾性分析了 2008 年至 2017 年期间在玛格丽特公主癌症中心和达勒姆地区癌症中心接受 NAC 联合 CRT 治疗的 MIBC 患者。吉西他滨联合顺铂 NAC 治疗 2-4 个周期，然后重新评估是否适合 CRT。6 周内给予外照射放疗（60-66 Gy），同时给予每周 40mg/m 的顺铂。采用 Kaplan-Meier 法进行生存分析。
结果
共纳入 57 例连续患者。中位年龄为 72 岁（范围 45-87 岁），所有患者的东部肿瘤协作组表现状态均为 0（60%）或 1（40%）。包括 II 期疾病（65%）、III 期疾病（25%）和区域淋巴结转移（11%）。大多数患者完成了计划的 NAC（95%）。所有患者均完成了外照射放疗，84%的患者至少完成了计划同步每周顺铂剂量的 60%。中位（范围）随访时间为 19.3（4.8-96.1）个月。中位总生存期（OS）未达到。2 年 OS 和疾病特异性生存率分别为 74%（95%置信区间，57.7-84.9）和 88%（95%置信区间，78.5-98.1）。2 年膀胱完整无病生存率为 64%。14%的患者接受了挽救性膀胱切除术。远处复发率为 11%，9%的患者死于转移性疾病。OS 与基线肾积水以及膀胱完整无病生存率与膀胱镜检查时残留疾病相关。
结论
对于符合顺铂治疗标准的患者，NAC 联合 CRT 可获得令人鼓舞的结果和可耐受的治疗效果。
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