Mazeron J J, Marinello G, Leung S, Le Bourgeois J P, Abbou C C, Auvert J, Pierquin B
Radiother Oncol. 1985;4(2):111-9. doi: 10.1016/s0167-8140(85)80097-9.
The technique and results of a treatment protocol for bladder cancer combining low dose pre-operative external beam irradiation followed by external iliac nodal dissection, limited partial cystectomy and curietherapy with iridium 192 are described. In 55 patients treated from 1971 to 1979, 37/45 (67%) are alive NED at 5 years--23/31 pT1, 10/14 pT2, 4/10 pT3--with 9/55 bladder recurrences at 5 years--7/31 pT1, 1/14 pT2, 1/10 pT3. Only two patients (total cystectomy) have not retained a functional bladder. These favorable results have been obtained in a carefully selected population; our indications for the technique being T1, T2, T3a tumors with a total surface area not exceeding 5 cm, not involving the bladder neck and unifocal or in some cases plurifocal, but closely grouped. The advantages and precise details of each stage of the technique will be described and compared with large series in which radium 226 is utilized and results of curietherapy will be compared with other modalities of treatment employed under similar circumstances for similar patient groups. We feel that curietherapy has certain advantages over other methods in the treatment of bladder cancer and that an afterloading technique employing iridium 192 wires permits the curietherapy to proceed under optimal conditions, allowing combination with partial cystectomy, optimal placement of sources, precise radiographic control and dosimetry, dose reduction in many cases, optimal conditions of radioprotection and widening of the indications for the technique.
本文描述了一种膀胱癌治疗方案的技术和结果，该方案包括术前低剂量外照射，随后进行髂外淋巴结清扫、局限性部分膀胱切除术以及使用铱192的近距离放射治疗。在1971年至1979年治疗的55例患者中，45例患者中的37例（67%）在5年时无疾病生存——pT1期23/31例，pT2期10/14例，pT3期4/10例——5年时膀胱复发9/55例——pT1期7/31例，pT2期1/14例，pT3期1/10例。仅2例患者（全膀胱切除术）未保留功能正常的膀胱。这些良好的结果是在经过精心挑选的人群中获得的；我们采用该技术的适应证为T1、T2、T3a期肿瘤，总表面积不超过5 cm，不累及膀胱颈，单灶性或在某些情况下为多灶性，但病灶紧密聚集。将描述该技术各阶段的优点和精确细节，并与使用镭226的大量病例系列进行比较，同时将近距离放射治疗的结果与在类似情况下针对类似患者群体采用的其他治疗方式的结果进行比较。我们认为，在膀胱癌治疗中，近距离放射治疗比其他方法具有某些优势，并且采用铱192线的后装技术可使近距离放射治疗在最佳条件下进行，允许与部分膀胱切除术相结合、优化源的放置、精确的影像学控制和剂量测定、在许多情况下降低剂量、实现最佳的放射防护条件以及扩大该技术的适应证。
