Fosså S D, Waehre H, Aass N, Jacobsen A B, Olsen D R, Ous S
Department of Medical Oncology and Radiotherapy, Norwegian Radium Hospital, Oslo.
Cancer. 1993 Nov 15;72(10):3036-43. doi: 10.1002/1097-0142(19931115)72:10<3036::aid-cncr2820721028>3.0.co;2-b.
The role of radiation therapy as curative treatment of muscle-invasive bladder cancer was to be analyzed.
From 1980-1990, 308 patients with transitional cell carcinoma of the urinary bladder received definitive pelvic radiation therapy (nominal standardized dose greater than or equal to 1700 ret). T categorization was based on clinical examination assessing the palpability of the bladder tumor and its extent (TNM 1978/1982).
The cancer-specific 5-year survival rate for all patients was 24% (crude survival, 20%). The 135 patients with T2/T3a tumors lived significantly longer (5-year survival, 38%) than those with greater than or equal to T3b tumors (5-year survival, 14%). In the former group of patients, age (75 years and younger versus older than 75 years) was significantly correlated with a favorable outcome. The cancer-specific 2-year survival was significantly correlated to clinical response assessed 3-4 months after radiation therapy was 72%, 38%, and 10% in cases of complete response, partial response, and no response/inevaluability, respectively. In a multivariate analysis, the T categorization, patient age, serum creatinine level (less than or equal to 150 mumol/l versus greater than 150 mumol/l), and radiation therapy schedule predicted the 5-year survival rate.
The clinical T category (< or = T3a versus > or = T3b), based on bimanual palpation, represents an important prognostic parameter, if done by clinicians experienced in onco-urology. High-dose radiation therapy offers a reasonable chance for long-term survival in patients with T2/T3 tumors confined to the bladder wall, especially in patients younger than 76 years. Greater than or equal to 80% of patients with more extended tumors (greater than or equal to T3b) and those older than 75 years of age are not curable by radiation therapy alone. In these patients palliative treatment modalities should be considered, in particular if cisplatin-based chemotherapy is not feasible.
分析放射治疗作为肌层浸润性膀胱癌根治性治疗手段的作用。
1980年至1990年，308例膀胱移行细胞癌患者接受了确定性盆腔放射治疗（名义标准化剂量大于或等于1700雷姆）。T分期基于临床检查评估膀胱肿瘤的可触及性及其范围（TNM 1978/1982）。
所有患者的癌症特异性5年生存率为24%（粗生存率为20%）。135例T2/T3a期肿瘤患者的生存期明显长于T3b期及以上肿瘤患者（5年生存率分别为38%和14%）。在前一组患者中，年龄（75岁及以下与75岁以上）与良好预后显著相关。放射治疗后3至4个月评估的临床反应与癌症特异性2年生存率显著相关，完全缓解、部分缓解和无反应/不可评估的病例中，2年生存率分别为72%、38%和10%。多因素分析中，T分期、患者年龄、血清肌酐水平（小于或等于150μmol/L与大于150μmol/L）和放射治疗方案可预测5年生存率。
基于双合诊的临床T分期（≤T3a与≥T3b）是一个重要的预后参数，前提是由有肿瘤泌尿学经验的临床医生进行评估。高剂量放射治疗为局限于膀胱壁的T2/T3期肿瘤患者提供了合理的长期生存机会，尤其是76岁以下的患者。肿瘤侵犯范围更广（≥T3b）的患者以及75岁以上的患者中，超过80%仅通过放射治疗无法治愈。在这些患者中，应考虑姑息性治疗方式，尤其是在基于顺铂的化疗不可行的情况下。
