Parsons J T, Million R R
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1988 Apr;14(4):797-810. doi: 10.1016/0360-3016(88)90102-2.
In recent years the role of planned preoperative irradiation in the management of clinical Stage B2-C (T3) bladder cancer has been questioned by a number of investigators. Much of the confusion regarding the efficacy of combined therapy results from studies that compare the results of treatment of pathological Stage B2-C patients treated by cystectomy alone versus clinical Stage B2-C patients treated by preoperative irradiation plus cystectomy. Such comparisons are biased because of (1) the exclusion of a large number of Stage D patients from cystectomy-alone series and their inclusion in preoperative irradiation plus cystectomy series and (2) the inclusion in the cystectomy-alone series of patients whose clinical stages were less than or equal to T2. The purpose of this paper is to compare the results of treatment in patients with clinical Stage B2-C bladder carcinoma following radical cystectomy alone versus preoperative irradiation plus cystectomy. This article reviews the rationale for administering preoperative irradiation, the effect of preoperative irradiation on the pathological specimen (including down-staging, the effect on regional lymph nodes, and radioresponsiveness according to tumor configuration, i.e., papillary vs. solid), the impact of preoperative irradiation on pelvic recurrence and 5-year survival, and the effect of preoperative irradiation on operative and postoperative complications. This paper cites all known literature on the subject in the English language. Data comparing 5-year survival results between radical cystectomy alone versus preoperative irradiation plus cystectomy are analyzed in three different ways: (a) retrospective comparisons of historical results, (b) review of the results of 6 randomized trials, and (c) comparison of concomitantly treated "modern-day" (1960-1980) series treated by either radical cystectomy alone versus preoperative irradiation plus cystectomy in 1185 patients. Preoperative results are also analyzed according to dose level (2000 rad versus 4000 rad versus 4500-5000 rad). The data presented indicate that the addition of preoperative irradiation to cystectomy for clinical Stage B2-C (T3) bladder cancer adds approximately 15 to 20 percentage points to the 5-year survival, leading to a survival figure that is approximately half-again that achieved by cystectomy alone.
近年来，一些研究人员对术前计划性放疗在临床B2 - C期（T3）膀胱癌治疗中的作用提出了质疑。关于联合治疗疗效的许多困惑源于一些研究，这些研究比较了单纯膀胱切除术治疗的病理B2 - C期患者与术前放疗加膀胱切除术治疗的临床B2 - C期患者的治疗结果。这种比较存在偏差，原因如下：（1）在单纯膀胱切除术系列中排除了大量D期患者，而将他们纳入术前放疗加膀胱切除术系列；（2）在单纯膀胱切除术系列中纳入了临床分期小于或等于T2的患者。本文的目的是比较单纯根治性膀胱切除术与术前放疗加膀胱切除术治疗临床B2 - C期膀胱癌患者的治疗结果。本文回顾了进行术前放疗的理论依据、术前放疗对病理标本的影响（包括降期、对区域淋巴结的影响以及根据肿瘤形态，即乳头状与实体状的放射反应性）、术前放疗对盆腔复发和5年生存率的影响，以及术前放疗对手术及术后并发症的影响。本文引用了所有关于该主题的英文已知文献。比较单纯根治性膀胱切除术与术前放疗加膀胱切除术5年生存结果的数据采用三种不同方式进行分析：（a）历史结果的回顾性比较；（b）6项随机试验结果的综述；（c）对1185例患者中单纯根治性膀胱切除术与术前放疗加膀胱切除术治疗的同期“现代”（1960 - 1980年）系列进行比较。术前结果也根据剂量水平（2000拉德与4000拉德与4500 - 5000拉德）进行分析。所呈现的数据表明，对于临床B2 - C期（T3）膀胱癌，在膀胱切除术中加用术前放疗可使5年生存率提高约15至20个百分点，使生存数字约为单纯膀胱切除术的一倍半。
