Kachnic L A, Shipley W U, Griffin P P, Zietman A L, Kaufman D S, Althausen A F, Heney N M
Genitourinary Oncology Unit, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Cancer J Sci Am. 1996 Mar-Apr;2(2):79-84.
To assess the physical, psychological, social, and organ-specific long-term treatment sequelae occurring in women with muscle-invading bladder carcinoma treated with combined modality therapy that allowed for bladder conservation in 67% of patients.
Patients with muscle-invading (T2-4a,Nx,M0) bladder cancer were treated with maximal transurethral resection followed by induction chemoradiotherapy (cisplatin x 2 plus 40 Gy pelvic irradiation or the same preceded by 2 cycles of methotrexate, cisplatin, and vinblastine) between the years 1986 and 1994. Women who had a complete response and all those who were not candidates for cystectomy received consolidation therapy of additional cisplatin and tumor boost to 64.8 Gy. Women who were incomplete responders and those who developed recurrent invasive tumor underwent immediate radical cystectomy. Forty-two women were treated with this approach, 21 of whom (median age, 69 years; median follow-up time, 56 months) were available for and underwent a structured interview of treatment and health-related issues using a quantitative symptom score.
All 21 patients have full urinary continence and no dysuria. Nineteen report unchanged or improved bladder capacity and function. No patient reported loss of bowel continence. Of the five women who were sexually active, two report an increase in intercourse frequency and one noted a decrease. There is no decrease in intercourse satisfaction or orgasm, and no dyspareunia or vaginal bleeding was noted. Eleven patients reported high levels of anxiety related to their bladder cancer before treatment. This was significantly reduced or absent in 9 of 11 after treatment. Actuarial overall survival for all 42 women was 58% at 5 years. Actuarial overall survival with an intact bladder was 47% at 5 years.
This study shows that overall survival is high when chemoradiation and transurethral resection are used in potential bladder-sparing protocols for muscle-invading transitional cell carcinoma of the bladder in women. Furthermore, 67% of the women, including most long-term survivors, retain their bladders. The functional quality of the conserved organ, the rectum, and the vagina, as reported by the patients, was excellent.
评估采用综合治疗方法治疗肌层浸润性膀胱癌女性患者所出现的身体、心理、社会及器官特异性长期治疗后遗症，该治疗方法使67%的患者得以保留膀胱。
1986年至1994年间，对肌层浸润性（T2 - 4a，Nx，M0）膀胱癌患者进行最大程度经尿道切除术，随后进行诱导放化疗（顺铂×2加40 Gy盆腔照射，或在上述治疗前先进行2周期甲氨蝶呤、顺铂和长春碱治疗）。完全缓解的女性患者以及所有不适合膀胱切除术的患者接受额外顺铂巩固治疗及肿瘤增敏至64.8 Gy。部分缓解的女性患者以及出现复发性浸润性肿瘤的患者立即接受根治性膀胱切除术。42名女性采用此方法治疗，其中21名（中位年龄69岁；中位随访时间56个月）可参与并接受了关于治疗及健康相关问题的结构化访谈，采用定量症状评分。
所有21名患者均完全控尿且无排尿困难。19名患者报告膀胱容量和功能未改变或有所改善。无患者报告大便失禁。5名有性生活的女性中，2名报告性交频率增加，1名报告减少。性交满意度或性高潮未降低，未发现性交困难或阴道出血。11名患者报告治疗前因膀胱癌焦虑程度较高。治疗后11名患者中有9名该情况明显减轻或消失。42名女性患者的5年精算总生存率为58%。保留膀胱的患者5年精算总生存率为47%。
本研究表明，对于女性肌层浸润性膀胱移行细胞癌采用潜在保留膀胱方案进行放化疗及经尿道切除术后，总体生存率较高。此外，67%的女性，包括大多数长期存活者，保留了膀胱。患者报告保留器官、直肠和阴道的功能质量良好。
