Quilty P M, Duncan W, Chisholm G D, Fowler J W, Hargreave T B, Newsam J E, Tolley D A
Br J Urol. 1986 Aug;58(4):396-405. doi: 10.1111/j.1464-410x.1986.tb09093.x.
Five hundred and ninety-one of 889 patients with T1 to T4 transitional cell carcinoma of the bladder had persistent or recurrent cancer after radical radiotherapy. Durable local control was significantly poorer for patients with grade 1 or T4 cancer before radiotherapy. Three hundred and twenty-two patients received additional surgical treatment: 211 were endoscopically managed and 111 had secondary cystectomy. The survival of patients with residual or recurrent cancer after radiotherapy was significantly improved by secondary local treatment (P less than 0.0001). A comparison was made between endoscopic treatment and cystectomy after radiotherapy. Patients having secondary cystectomy were younger (mean age 60.0 years) than those managed endoscopically (66.8 years). The 5-year actuarial survival rate (from the date of radiotherapy) for patients who had endoscopic treatment was 47.1% compared with 62.5% for those who had cystectomy (P = 0.16). After both treatments survival was significantly correlated with the T category of the tumour before radiotherapy. Local tumour control was better after cystectomy; 85.6% of patients were locally tumour-free at the end of follow-up compared with 44.5% of those managed endoscopically. There was no overall difference in the subsequent risk of metastases between the two forms of surgery. However, seven of 12 patients managed endoscopically prior to secondary cystectomy died of their cancer. Five of these patients died from metastases even though they were locally disease-free. There was a significantly increased risk of metastases in patients managed endoscopically who were not locally disease-free after treatment (P = 0.0003). Caution is advised in persisting with endoscopic treatment after radiotherapy if local control is not readily achieved.
889例膀胱T1至T4期移行细胞癌患者中，591例在根治性放疗后出现持续性或复发性癌症。放疗前1级或T4期癌症患者的持久局部控制明显较差。322例患者接受了额外的手术治疗：211例接受内镜治疗，111例接受二期膀胱切除术。放疗后残留或复发性癌症患者通过二次局部治疗，生存率显著提高（P<0.0001）。对放疗后的内镜治疗和膀胱切除术进行了比较。接受二期膀胱切除术的患者比接受内镜治疗的患者年轻（平均年龄60.0岁对66.8岁）。接受内镜治疗的患者放疗后5年精算生存率为47.1%，而接受膀胱切除术的患者为62.5%（P=0.16）。两种治疗后，生存率均与放疗前肿瘤的T分期显著相关。膀胱切除术后局部肿瘤控制更好；随访结束时，85.6%的患者局部无肿瘤，而接受内镜治疗的患者为44.5%。两种手术方式后续转移风险无总体差异。然而，12例在二期膀胱切除术前行内镜治疗的患者中有7例死于癌症。其中5例患者即使局部无病也死于转移。治疗后局部未达到无病状态的内镜治疗患者转移风险显著增加（P=0.0003）。如果不能轻易实现局部控制，建议放疗后坚持内镜治疗时要谨慎。
