Herr H W, Yagoda A, Batata M, Sogani P C, Whitmore W F
Cancer. 1983 Dec 15;52(12):2205-8. doi: 10.1002/1097-0142(19831215)52:12<2205::aid-cncr2820521205>3.0.co;2-l.
Cisplatin (DDP) is an active agent in the treatment of disseminated bladder cancer. In addition to its direct tumor cytotoxicity, recent animal and clinical data suggest synergism with radiation therapy (RT). Since improved survival with preoperative RT is largely restricted to bladder cancer patients in whom radiation-induced downstaging (P less than T) may be recognized, the authors administered DDP + RT preoperatively to patients with locally advanced (T3, T4) bladder tumors selected for cystectomy. The aim was to evaluate the feasibility of such a combination in relation to surgical and hematologic complications, the immediate effect on tumor downstaging, disease progression, and survival. Two thousand rad (400 rad X 5 days) was delivered to the whole pelvis, followed by cystectomy in 2 days. DDP (70 mg/m2) was given intravenously on day 2 of the RT. Twenty-four patients received preoperative DDP + RT and underwent attempted cystectomy; however, six patients were nonresectable owing to extensive pelvic disease, and an additional five patients had resectable pelvic lymph node metastases. Pelvic complications developed in 3 of 24 (12%) patients, but none required reoperation. No patient had a wound dehiscence. Transient myelosuppression was similar to that induced by 2000 rad preoperative RT alone. Tumor downstaging (P less than T) was seen in 9 of 24 (38%) patients, and in 5 (21%) patients, no tumor was found in the surgical specimen (P0). Distant metastases alone have been detected in 4 of 18 (22%) patients who had a cystectomy (all 4 had nodal metastases). Disease-free survival at a median follow-up of 22 months (range, 12-34 months) is 60% (14/24) for all patients (89% for P less than T and 40% for P greater than or equal to T patients) and 78% (14/18) for the resected patients. Combined preoperative DDP + RT proved to be a safe and feasible regimen which resulted in a possibly greater recognition of radioresponsive bladder tumors, and after cystectomy, an encouraging early survival rate in patients with locally advanced disease.
顺铂（DDP）是治疗播散性膀胱癌的一种有效药物。除了其直接的肿瘤细胞毒性外，最近的动物和临床数据表明它与放射治疗（RT）具有协同作用。由于术前放疗提高生存率主要局限于那些可能出现放疗诱导分期降低（P小于T）的膀胱癌患者，因此作者对选择进行膀胱切除术的局部晚期（T3、T4）膀胱肿瘤患者术前给予顺铂+放疗。目的是评估这种联合治疗在手术和血液学并发症、对肿瘤分期降低的即时影响、疾病进展及生存率方面的可行性。对整个盆腔给予2000拉德（400拉德×5天），然后在2天后进行膀胱切除术。顺铂（70mg/m²）在放疗的第2天静脉给予。24例患者接受了术前顺铂+放疗并尝试进行膀胱切除术；然而，6例患者因广泛的盆腔疾病无法切除，另外5例患者有可切除的盆腔淋巴结转移。24例患者中有3例（12%）出现盆腔并发症，但均无需再次手术。没有患者出现伤口裂开。短暂的骨髓抑制与单独术前给予2000拉德放疗所诱导的情况相似。24例患者中有9例（38%）出现肿瘤分期降低（P小于T），5例（21%）患者手术标本中未发现肿瘤（P0）。在18例接受膀胱切除术的患者中，有4例（22%）仅检测到远处转移（所有4例均有淋巴结转移）。所有患者在中位随访22个月（范围12 - 34个月）时的无病生存率为60%（14/24）（P小于T的患者为89%，P大于或等于T的患者为40%），接受手术切除患者的无病生存率为78%（14/18）。术前联合顺铂+放疗被证明是一种安全可行的方案，这可能会使对放疗反应性膀胱肿瘤有更多的认识，并且在膀胱切除术后，局部晚期疾病患者的早期生存率令人鼓舞。
