Maulard-Durdux C, Dufour B, Hennequin C, Chrétien Y, Vignes B, Droz D, Delanian S, Housset M
Department of Radiation Therapy, St. Louis Hospital, Paris, France.
J Urol. 1996 Jan;155(1):115-7.
To evaluate the role of adjuvant radiation therapy in invasive transitional cell carcinoma of the upper urinary tract, we retrospectively reviewed a series of 26 patients who underwent radical surgery plus postoperative prophylactic irradiation for such a tumor.
Between February 1980 and October 1993, 18 men and 8 women (mean age 65 +/- 9 years, standard deviation) were treated for an invasive transitional cell carcinoma of the upper urinary tract. Tumor location was the renal pelvis in 15 patients (58%). The tumor was pathological stage B in 11 patients (42%) and stage C in 15 (58%). Tumor grade was 2 in 10 patients, 3 in 15 and unknown in 1. One patient had epidermoid metaplasia of urothelial cancer and 9 had node involvement. All patients underwent surgery followed by radiation therapy to a total dose of 45 Gy. to the tumor bed (23) and/or regional nodes (18).
After a mean followup of 45 months 13 patients (50%) were alive and 11 were disease-free at analysis. Local tumor relapse, nodal recurrence and metastasis were noted in 1, 4 (15%) and 14 (54%) patients, respectively. All patients with nodal recurrence had metastasis. A secondary location was noted frequently (6 bladder, 1 contralateral renal pelvis and 1 urethral tumors). Overall 5-year survival rate and 5-year survival rate with no evidence of disease were 49% and 30%, respectively. Overall 5-year survival rates were 60% for stage B and 19% for stage C disease (p = 0.07), 49% for node-negative versus 15% for node-positive cancer (p = 0.04), and 90% for grade 2 and 0% for grade 3 tumors (p < 0.01).
In our trial using a radio-surgical approach, local control of disease and survival rates were similar to those reported previously in surgical series. Prophylactic postoperative radiation therapy is not recommended except in prospective randomized studies.
为评估辅助性放射治疗在上尿路浸润性移行细胞癌中的作用，我们回顾性分析了26例行根治性手术加术后预防性放疗的此类肿瘤患者。
1980年2月至1993年10月期间，18例男性和8例女性（平均年龄65±9岁，标准差）接受了上尿路浸润性移行细胞癌治疗。肿瘤位于肾盂的患者有15例（58%）。11例患者（42%）的肿瘤病理分期为B期，15例（58%）为C期。10例患者肿瘤分级为2级，15例为3级，1例分级未知。1例患者有尿路上皮癌的鳞状化生，9例有淋巴结受累。所有患者均接受手术，随后对肿瘤床（23例）和/或区域淋巴结（18例）进行总量为45 Gy的放射治疗。
平均随访45个月后，分析时13例患者（50%）存活，11例无疾病。分别有1例、4例（15%）和14例（54%）患者出现局部肿瘤复发、淋巴结复发和转移。所有淋巴结复发患者均有转移。常发现有继发部位（6例膀胱、1例对侧肾盂和1例尿道肿瘤）。总体5年生存率和无疾病证据的5年生存率分别为49%和30%。B期疾病的总体5年生存率为60%，C期为19%（p = 0.07）；淋巴结阴性癌症为49%，淋巴结阳性癌症为15%（p = 0.04）；2级肿瘤为90%，3级肿瘤为0%（p < 0.01）。
在我们采用手术联合放疗的试验中，疾病的局部控制和生存率与先前手术系列报道的相似。除前瞻性随机研究外，不建议进行术后预防性放射治疗。
