Kaplan S A, Sawczuk I S, O'Toole K, Olsson C A
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
Urology. 1988 Dec;32(6):485-91. doi: 10.1016/s0090-4295(98)90026-7.
The role of preoperative radiation therapy (RT) as an adjunct to radical cystectomy (C) was studied by reviewing 58 consecutive patients requiring bladder removal during 1980-1982 for transitional cell carcinoma (TCC). Thirty-six patients underwent RT + C; 22 had C alone. The sole reason for choosing between RT + C versus C was physician prejudice favoring one form of therapy over another. Pretreatment clinical staging was similar in both groups, slightly favoring the RT + C group with only 25 percent versus 36 percent of C patients with clinical stage exceeding B1. Pathologic stage distribution similarly favored the RT + C group slightly with only 56 percent versus 68 percent of C patients having lesions with P-stage greater than B1. Thirty-three percent of patients in the RT + C group had papillary lesions in contrast to only 27 percent in the C alone group. There was only one postoperative death in each group. Three-year minimal follow-up was available in all surviving patients. One-, two-, and three-year survival free of disease was 94 percent, 80 percent, and 70 percent, respectively, in the group treated by C alone. Similar figures for the RT + C group were 86 percent, 76 percent, and 60 percent, respectively. Projected five-year survival rates for both groups regardless of preoperative RT was over 60 percent. All but one failure in the RT + C group had 4,000 rad or more preoperative radiation. This contemporary study shows no advantage of preoperative radiation in patients requiring cystectomy for transitional cell carcinoma of the bladder.
通过回顾1980年至1982年间因移行细胞癌（TCC）需要膀胱切除的58例连续患者，研究了术前放射治疗（RT）作为根治性膀胱切除术（C）辅助治疗的作用。36例患者接受了RT + C；22例仅接受了C。在RT + C与C之间做出选择的唯一原因是医生对一种治疗形式优于另一种治疗形式的偏见。两组的术前临床分期相似，略微有利于RT + C组，临床分期超过B1的患者仅占25%，而C组为36%。病理分期分布同样略微有利于RT + C组，P分期大于B1的病变患者仅占56%，而C组为68%。RT + C组33%的患者有乳头状病变，而仅接受C组的这一比例为27%。每组均只有1例术后死亡。所有存活患者均有三年的最低随访期。仅接受C组的1年、2年和3年无病生存率分别为94%、80%和70%。RT + C组的类似数字分别为86%、76%和60%。无论术前是否进行RT，两组预计的五年生存率均超过60%。RT + C组除1例失败外，所有患者术前均接受了4000拉德或更多的放射治疗。这项当代研究表明，对于因膀胱移行细胞癌需要膀胱切除的患者，术前放疗没有优势。
