Polineni Praneet, Ashack Laura, Kalapurakal John, Morgans Alicia, VanderWeele David, Kundu Shilajit, Hussain Maha, Meeks Joshua, Sachdev Sean
Departments of Radiation Oncology.
Medicine, Hematology and Oncology Division.
Adv Radiat Oncol. 2021 May 20;6(5):100718. doi: 10.1016/j.adro.2021.100718. eCollection 2021 Sep-Oct.
As an alternative to radical cystectomy, tri-modality treatment (TMT) is an effective treatment approach for selected patients with muscle-invasive bladder cancer (MIBC). The purpose of this report is to contribute to the literature by summarizing institutional outcomes of a bladder-preserving TMT approach for patients with MIBC.
Patients treated with TMT for MIBC from 1998 to 2019 were identified. Patient, disease, and treatment factors were recorded. Overall survival (OS), disease-free survival (DFS), and bladder-preserved DFS were estimated with the Kaplan-Meier method. Prognostic factors were evaluated with Cox proportional hazards regression.
Thirty-two patients treated with TMT to a median dose of 64.8 Gy for T2 (78%), T3 (19%), and T4 (3%) disease were followed for a median of 19 months (mean, 36; range, 6-213); 31% had associated carcinoma in situ; 25% had associated hydronephrosis. Cisplatin was the most commonly used chemotherapeutic agent. OS rates were 84% at 1 year and 61% at 5 years. DFS rates were 84% and 61% and bladder-preserved DFS rates were 84% and 60% at 1 year and 5 years, respectively. Salvage cystectomy rates at 1 year and 5 years were 4% and 9%, respectively. Four patients had locally invasive recurrences at 8, 11, 34, and 37 months after initial MIBC diagnosis, 2 of whom underwent salvage radical cystectomy. Ten (31%) patients developed distant disease at a median of 13 months after diagnosis. Unlike local recurrence, distant recurrences were associated with worse OS and hazard ratios of 3.4 ( = 0.039).
OS and DFS were comparable to those of published data. Our outcomes support TMT as an effective option for carefully selected patients with MIBC.
作为根治性膀胱切除术的替代方法，三联疗法（TMT）是治疗特定肌肉浸润性膀胱癌（MIBC）患者的有效治疗方法。本报告的目的是通过总结MIBC患者保留膀胱的TMT方法的机构治疗结果，为相关文献提供参考。
确定1998年至2019年接受TMT治疗的MIBC患者。记录患者、疾病和治疗因素。采用Kaplan-Meier法估计总生存期（OS）、无病生存期（DFS）和保留膀胱的DFS。用Cox比例风险回归评估预后因素。
32例接受TMT治疗的患者，T2期（78%）、T3期（19%）和T4期（3%）疾病的中位剂量为64.8 Gy，中位随访时间为19个月（平均36个月；范围6 - 213个月）；31%伴有原位癌；25%伴有肾积水。顺铂是最常用的化疗药物。1年和5年的OS率分别为84%和61%。1年和5年的DFS率分别为84%和61%，保留膀胱的DFS率分别为84%和60%。1年和5年的挽救性膀胱切除率分别为4%和9%。4例患者在初次诊断MIBC后8、11、34和37个月出现局部浸润性复发，其中２例接受了挽救性根治性膀胱切除术。10例（31%）患者在诊断后中位13个月出现远处转移。与局部复发不同，远处复发与较差的OS相关，风险比为3.4（P = 0.039）。
OS和DFS与已发表数据相当。我们的结果支持TMT作为精心挑选的MIBC患者的有效选择。
