Soete G, Coen V, Verellen D, Keuppens F, De Boe V, Storme G
Department of Radiotherapy, Oncologic Center, Academic Hospital Free University of Brussels, Belgium.
Int J Radiat Oncol Biol Phys. 1997 Jul 1;38(4):743-7. doi: 10.1016/s0360-3016(97)00063-1.
To determine the feasibility of high dose rate brachytherapy in the treatment of T1-T3 solitary bladder cancer and to compare results and side-effects to those obtained by others using conventional, i.e., low dose rate regimens.
Between July 1992 and 1995, 16 patients entered the study. Median age at diagnosis was 64 years (range: 45-79 years). Diagnostic transurethral resection showed four T1, five T2, and seven T3 lesions, all proven solitary by random biopsies. Radiotherapy consisted of low-dose preoperative external beam irradiation (3 x 3.5 Gy on the 3 consecutive days prior to implantation), followed by high dose rate brachytherapy (15 x 3 Gy during the 8 consecutive days thereafter). Median follow-up from the date of implantation was 23 months (range: 6-43 months). In 15 patients, cystoscopy was systematically performed during follow-up, whereas the 16th patient was followed on a clinical basis only.
Recurrences have occurred in 2 of 15 evaluable patients (both stage T3): metastasis in 1 and combined local plus distant failure in the other patient. Cystoscopic evaluation showed persisting alterations of the implanted portion of the bladder mucosa in 11 of 15 evaluable patients (ulceration, calcifications, and/or punctiform bleedings). Symptomatic radiation cystitis was mild and transient in 14 but persisting and severe in 2 patients.
This study documents the feasibility of high dose rate brachytherapy in a selected group of bladder cancer patients. Both patient outcome and side-effects are comparable to the best results obtained with low dose rate schedules. Additional follow-up is still needed to enforce the comparison.
确定高剂量率近距离放射疗法治疗T1 - T3期孤立性膀胱癌的可行性，并将其结果和副作用与其他人使用传统（即低剂量率方案）所获得的结果进行比较。
1992年7月至1995年期间，16例患者进入本研究。诊断时的中位年龄为64岁（范围：45 - 79岁）。诊断性经尿道切除术显示有4例T1病变、5例T2病变和7例T3病变，所有病变经随机活检均证实为孤立性。放疗包括术前低剂量外照射（植入前连续3天，每天3×3.5 Gy），随后进行高剂量率近距离放射疗法（此后连续8天，每天15×3 Gy）。从植入日期起的中位随访时间为23个月（范围：6 - 43个月）。15例患者在随访期间系统地进行了膀胱镜检查，而第16例患者仅进行临床随访。
15例可评估患者中有2例出现复发（均为T3期）：1例发生转移，另1例出现局部加远处联合失败。膀胱镜评估显示，15例可评估患者中有11例膀胱黏膜植入部位持续存在改变（溃疡、钙化和/或点状出血）。14例患者的放射性膀胱炎症状轻微且短暂，但有2例患者症状持续且严重。
本研究证明了高剂量率近距离放射疗法在选定的膀胱癌患者群体中的可行性。患者的治疗结果和副作用与低剂量率方案所获得的最佳结果相当。仍需要进一步随访以加强比较。
