Chen Yatong, Luo Fei, Li Jian, Zhang Tingji
Department of Urology, Tianjin Union Medical Center, Tianjin, China.
The First Affiliated Hospital of Nankai University, Tianjin, China.
Photobiomodul Photomed Laser Surg. 2025 Jul;43(7):302-309. doi: 10.1089/photob.2024.0150. Epub 2025 Jun 16.
To evaluate the efficacy and safety of neoadjuvant radiotherapy combined with transurethral photoselective vaporization of bladder tumors (PVBT), followed by postoperative adjuvant radiotherapy and chemotherapy, in the treatment of T3 muscle-invasive bladder cancer (MIBC). Transurethral resection of bladder tumors combined with radiotherapy and chemotherapy, also known as trimodal therapy (TMT), is the recommended bladder-preserving approach for MIBC and has demonstrated favorable outcomes in T2 MIBC. However, T3 MIBC remains a challenging candidate for TMT due to its relatively poor prognosis. Therefore, optimizing the "triple therapy" strategy for T3 MIBC is essential. This was a retrospective case series. Patients with T3 MIBC who underwent preoperative neoadjuvant radiotherapy combined with PVBT, followed by postoperative adjuvant radiotherapy and chemotherapy, between January 2018 and December 2020 were included. Tumor response after neoadjuvant radiotherapy, the incidence of PVBT-related complications, and adverse effects of radiotherapy and chemotherapy were assessed. Tumor recurrence and survival outcomes were monitored through outpatient follow-ups and telephone consultations. Risk factors for recurrence were analyzed using statistical methods. A total of 48 patients were included. Four weeks after neoadjuvant radiotherapy, complete response, partial response, stable disease, and disease progression were observed in 3 (6.3%), 23 (47.9%), 20 (41.7%), and 2 (4.2%) patients, respectively. The objective response rate and disease control rate were 54.2% and 95.8%, respectively. Radiation- or chemotherapy-related toxicity occurred in 23 patients (47.9%), all of whom experienced only grade I-II adverse effects, with no grade III-IV toxicity reported. During a follow-up period of 14-58 months, 22 patients (45.83%) experienced recurrence, and 3 patients died due to distant organ metastases. Multi-variate Cox regression analysis identified tumor diameter (≤3.0 cm vs. >3.0 cm) and tumor multiplicity (single vs. multiple) as significant risk factors for recurrence. Preoperative neoadjuvant radiotherapy combined with PVBT, followed by postoperative adjuvant radiotherapy and chemotherapy, is an effective and well-tolerated treatment for T3 MIBC.
评估新辅助放疗联合经尿道膀胱肿瘤光选择性汽化术（PVBT），随后进行术后辅助放疗和化疗，在治疗T3期肌层浸润性膀胱癌（MIBC）中的疗效和安全性。经尿道膀胱肿瘤切除术联合放疗和化疗，也称为三联疗法（TMT），是推荐的MIBC保膀胱方法，并且已在T2期MIBC中显示出良好的疗效。然而，由于T3期MIBC预后相对较差，它仍然是TMT的一个具有挑战性的候选对象。因此，优化T3期MIBC的“三联疗法”策略至关重要。这是一项回顾性病例系列研究。纳入了2018年1月至2020年12月期间接受术前新辅助放疗联合PVBT，随后进行术后辅助放疗和化疗的T3期MIBC患者。评估了新辅助放疗后的肿瘤反应、PVBT相关并发症的发生率以及放疗和化疗的不良反应。通过门诊随访和电话咨询监测肿瘤复发和生存结果。使用统计方法分析复发的危险因素。共纳入48例患者。新辅助放疗4周后，分别有3例（6.3%）、23例（47.9%）、20例（41.7%）和2例（4.2%）患者出现完全缓解、部分缓解、病情稳定和疾病进展。客观缓解率和疾病控制率分别为54.2%和95.8%。23例患者（47.9%）发生了与放疗或化疗相关的毒性反应，所有患者仅经历了I-II级不良反应，未报告III-IV级毒性反应。在14 - 58个月的随访期内，22例患者（45.83%）出现复发，3例患者因远处器官转移死亡。多变量Cox回归分析确定肿瘤直径（≤3.0 cm与>3.0 cm）和肿瘤数量（单发与多发）是复发的重要危险因素。术前新辅助放疗联合PVBT，随后进行术后辅助放疗和化疗，是一种治疗T3期MIBC有效且耐受性良好的治疗方法。
