Dunst J, Sauer R, Schrott K M, Kühn R, Wittekind C, Altendorf-Hofmann A
Department of Radiotherapy, University of Erlangen, Germany.
Int J Radiat Oncol Biol Phys. 1994 Sep 30;30(2):261-6. doi: 10.1016/0360-3016(94)90003-5.
Radical cystectomy is considered as standard therapy for muscle-invasive bladder cancer. We present 10-year results of bladder-sparing treatment by conservative surgery and radiotherapy +/- chemotherapy.
From 1982 through 1991, 245 consecutive patients, mean age 66 years, with invasive bladder cancer (T2-3 or poor prognostic T1, no distant metastases) entered a prospective protocol with the objective of bladder preservation. Treatment consisted of transurethral resection (complete, if possible) and definitive radiotherapy with 56 Gy maximum dose (50.4 Gy minimum target dose) in 28 fractions. Since 1985, 139 patients received a simultaneous chemotherapy on 5 days in the first and fifth treatment week with either 25 mg/m2 cisplatin daily (79 patients) or 65 mg/m2 carboplatin (60 patients). Cystectomy was performed as salvage treatment for residual or recurrent invasive disease. The median follow-up at the date of analysis (12-31-92) was 5.9 years.
The overall survival was 47% after 5 years and 26% after 10 years. The 5-year survival according to the initial T-category was 60% for T1 (44 patients), 64% for T2 (47 patients), 43% for T3 (127 patients), and 16% for T4 (23 patients). The most important single prognostic factor was the amount of residual tumor after TUR (5-year survival 80% after R0, 53% after R1, and 31% after R2 resection, p < 0.01). Chemotherapy increased the rate of complete remission, but had no impact on 5-year survival (52% vs. 50%). Fifty-three salvage cystectomies were performed, all without severe complications, and 192 patients (79%) maintained a normal functioning bladder. The bladder preservation rate in 5-year survivors was 83%.
Organ-sparing treatment of advanced bladder cancer by transurethral surgery and definitive radiotherapy or radiochemotherapy is feasible and effective. The survival in this series is as good as in any comparable cystectomy series. Eighty-three percent of long-term survivors maintained their functioning bladders.
根治性膀胱切除术被视为肌层浸润性膀胱癌的标准治疗方法。我们展示了通过保守手术和放疗±化疗进行膀胱保留治疗的10年结果。
1982年至1991年，245例连续患者，平均年龄66岁，患有浸润性膀胱癌（T2 - 3期或预后不良的T1期，无远处转移）进入了一项旨在保留膀胱的前瞻性方案。治疗包括经尿道切除术（尽可能完整切除）以及最大剂量56 Gy（最小靶剂量50.4 Gy）分28次进行的根治性放疗。自1985年起，139例患者在第一个和第五个治疗周的5天内同时接受化疗，其中79例患者每日使用顺铂25 mg/m²，60例患者使用卡铂65 mg/m²。对于残留或复发性浸润性疾病，进行膀胱切除术作为挽救性治疗。分析时（1992年12月31日）的中位随访时间为5.9年。
5年总生存率为47%，10年为26%。根据初始T分期的5年生存率，T1期（44例患者）为60%，T2期（47例患者）为64%，T3期（127例患者）为43%，T4期（23例患者）为16%。最重要的单一预后因素是经尿道切除术后残留肿瘤的数量（R0切除后5年生存率为80%，R1切除后为53%，R2切除后为31%，p < 0.01）。化疗提高了完全缓解率，但对5年生存率无影响（分别为52%和50%）。进行了53例挽救性膀胱切除术，均无严重并发症，192例患者（79%）保持膀胱功能正常。5年幸存者中的膀胱保留率为83%。
通过经尿道手术和根治性放疗或放化疗对晚期膀胱癌进行器官保留治疗是可行且有效的。本系列中的生存率与任何可比的膀胱切除术系列相当。83%的长期幸存者保持了膀胱功能。
