Prié L, Gaston R, Ferrière J M, Richaud P, Bui B N, Guillou M L
Service de radiothérapie, Institut Bergonié, centre régional de lutte contre le cancer, Bordeaux, France.
Cancer Radiother. 1998 Apr;2 Suppl 1:62s-66s.
Retrospective evaluation of tolerance and efficacity of a combination of chemotherapy and radiotherapy in non metastatic invasive cancer of the bladder.
From 1984 to 1995, 36 patients presenting with invasive urothelial carcinoma of the bladder were treated conservatively with primary chemotherapy: cisplatin-methotrexate-vinblastine (24 patients), methotrexate-vinblastine-doxorubicin-cisplatin (11 patients) or carboplatin (one patient). Fourty-six Gy were then delivered by external radiation therapy to the pelvis, with a complement of 10 to 20 Gy to the bladder. Seventeen patients received a concomitant chemotherapy with cisplatin.
The intolerance to chemotherapy was hematologic and digestive. One patient died from bone marrow depletion. External irradiation was well tolerated, except for one patient whose treatment was stopped at 48 Gy. Fifteen tumours (44%) were in complete remission (CR) after chemotherapy and 23 (64%) at the end of treatment. With a median follow up of 64.6 months, 13 out of 23 patients in CR had a relapse (ten local relapses, three metastatic); five salvage cystectomies were done. The median survival and 26 months and the probability of survival at 5 years was 43%. All but two patients surviving 5 years had a functional bladder.
Neoadjuvant chemotherapy leads to CR in 44% of patients and CR is observed in 64% of the patients after radiation therapy. However, the survival rate at 5 years is insufficient, even if the rate of bladder conservation is high.
回顾性评估化疗与放疗联合治疗非转移性浸润性膀胱癌的耐受性和疗效。
1984年至1995年，36例浸润性膀胱尿路上皮癌患者接受了以顺铂-甲氨蝶呤-长春花碱（24例）、甲氨蝶呤-长春花碱-阿霉素-顺铂（11例）或卡铂（1例）为主的初始化疗。随后通过盆腔外照射给予46 Gy，对膀胱追加10至20 Gy。17例患者接受了顺铂同步化疗。
化疗不耐受表现为血液学和消化系统反应。1例患者死于骨髓耗竭。除1例患者在48 Gy时停止治疗外，外照射耐受性良好。化疗后15个肿瘤（44%）完全缓解（CR），治疗结束时23个（64%）完全缓解。中位随访64.6个月，23例CR患者中有13例复发（10例局部复发，3例转移）；进行了5例挽救性膀胱切除术。中位生存期为26个月，5年生存率为43%。除2例患者外，所有存活5年的患者膀胱功能均正常。
新辅助化疗使44%的患者达到CR，放疗后64%的患者达到CR。然而，即使膀胱保留率较高，5年生存率仍不足。
