Cummings K B, Taylor W J, Correa R J, Gibbons R P, Mason J T
J Urol. 1976 Feb;115(2):152-4. doi: 10.1016/s0022-5347(17)59109-0.
Radiation therapy will result in tumor disappearance in a select number of patients. However, it does not prevent local recurrence and, therefore, the patient continues at risk. Tumor recurrence was noted in more than half the patients in our series and more than 50 per cent of these patients experienced multiple recurrences. A functional bladder was maintained in nearly 60 per cent of the patients. Survival in 11 patients in category 1 with radiation therapy and subsequent non-ablative extirpative surgical procedures in 8 patients was equivalent to series treated by preoperative irradiation and cystectomy. In contrast the 14 patients in category 2 had a survival rate that was appreciably lower than that obtained with preoperative irradiation followed by cystectomy. There was a significantly increased morbidity associated with an open operation in the treatment of recurrence in the irradiated patient. We would advocate preoperative irradiation followed by cystectomy in the patients with high grade and high stage disease. The value of single versus adjuvant forms of therapy for patients with diffuse, rapidly recurring low grade and low stage disease would be determined best by a randomized prospective study. Evidence from this series suggests that irradiation improved over-all survival in this category.
放射治疗将使部分患者的肿瘤消失。然而，它并不能预防局部复发，因此，患者仍有复发风险。在我们的系列研究中，超过半数的患者出现了肿瘤复发，其中超过50%的患者经历了多次复发。近60%的患者保留了功能性膀胱。11例接受放射治疗的1类患者以及8例随后接受非根治性切除手术患者的生存率，与术前放疗加膀胱切除术治疗的系列患者相当。相比之下，2类中的14例患者的生存率明显低于术前放疗加膀胱切除术后的生存率。在接受放疗的患者中，开放性手术治疗复发的发病率显著增加。对于高分级、高分期疾病的患者，我们主张术前放疗加膀胱切除术。对于弥漫性、快速复发的低分级、低分期疾病患者，单一治疗与辅助治疗的价值最好通过随机前瞻性研究来确定。本系列研究的证据表明，放疗可提高此类患者的总体生存率。
