Chauvet B, Brewer Y, Félix-Faure C, Davin J L, Vincent P, Reboul F
Unité de Traitement des Cancers Urologiques, Clinique Sainte Catherine, Avignon, France.
Cancer. 1993 Oct 1;72(7):2213-8. doi: 10.1002/1097-0142(19931001)72:7<2213::aid-cncr2820720724>3.0.co;2-3.
This study evaluates feasibility and results of combined treatment of cisplatin and radiation therapy for patients with inoperable invasive bladder carcinoma.
From January 1988 to October 1991, 69 patients received radiation therapy and concomitant cisplatin. Median age was 71 years. Most tumors were locally advanced and high grade. A macroscopically complete transurethral resection was performed initially in 18 patients. Dose of pelvic radiation ranged from 40 Gy to 45 Gy, and total dose to the bladder ranged from 55 Gy to 60 Gy. Concomitant continuous cisplatin infusion at a dose of 20-25 mg/m2/day for 5 days was delivered during the 2nd and 5th weeks of radiation.
As of April 1993, the median follow-up time was 36.4 months (range, 18-70 months). Ninety-one percent of the patients completed radiation therapy as planned, and 78.3% completed two courses of chemotherapy. Despite one treatment-related death due to renal failure, toxicity was generally mild and acceptable. Sixty-three patients were evaluable for response. Forty-eight patients (76.2%) achieved a complete response. Actuarial overall 3-year survival rate was 37.1% for all patients. Among the patients who experienced complete response, the 3-year actuarial local control and disease-free survival rates were 65.4% and 56.3%, respectively. Twenty-six patients (37.7%) are alive and disease-free with bladder preservation. One patient is alive and disease-free after salvage cystectomy.
Concomitant cisplatin and radiation therapy offers high probability of complete response and local control in patients with invasive bladder cancer unsuitable for surgery. These results provide a basis for randomized studies comparing this approach with conventional therapy for patients with operable carcinoma.
本研究评估顺铂与放射治疗联合应用于无法手术切除的浸润性膀胱癌患者的可行性及疗效。
1988年1月至1991年10月，69例患者接受放射治疗并同步使用顺铂。中位年龄为71岁。大多数肿瘤为局部晚期且分级较高。18例患者最初接受了宏观上完整的经尿道切除术。盆腔放疗剂量为40 Gy至45 Gy，膀胱总剂量为55 Gy至60 Gy。在放疗的第2周和第5周期间，同步持续输注顺铂，剂量为20 - 25 mg/m²/天，共5天。
截至1993年4月，中位随访时间为36.4个月（范围18 - 70个月）。91%的患者按计划完成了放射治疗，78.3%的患者完成了两个疗程的化疗。尽管有1例患者因肾衰竭导致与治疗相关的死亡，但毒性一般较轻且可接受。63例患者可评估疗效。48例患者（76.2%）达到完全缓解。所有患者的3年总生存率精算值为37.1%。在达到完全缓解的患者中，3年精算局部控制率和无病生存率分别为65.4%和56.3%。26例患者（37.7%）存活且无疾病，膀胱得以保留。1例患者在挽救性膀胱切除术后存活且无疾病。
顺铂与放射治疗联合应用，对于不适于手术的浸润性膀胱癌患者，有较高的完全缓解率和局部控制率。这些结果为将该方法与可手术切除癌患者的传统治疗进行比较的随机研究提供了依据。
