动脉介入化疗、适形放疗联合绿激光治疗肌层浸润性膀胱癌的初步体会

Combination of intraarterial chemotherapy, three dimensional conformal radiotherapy and transurethral photoselective vaporization for the treatment of muscle-invasive bladder cancer

目的 评价动脉介入化疗、适形放疗联合绿激光治疗肌层浸润性膀胱癌的疗效及安全性. 方法 2009年11月至2012年11月对16例无法耐受或不接受膀胱全切手术的肌层浸润性膀胱癌患者采用动脉介入化疗、适形放疗联合绿激光治疗.男13例,女3例.年龄63 ～ 86岁,平均74岁.病程10 d～3个月.临床分期为T2期9例、T3期7例,肿瘤分级G13例、G210例、G33例.肿瘤直径3～6 cm,平均3.5 cm.合并较严重心脑血管疾病11例,重度肺通气功能障碍3例,要求保留膀胱2例.化疗药物包括顺铂80 mg、吡柔比星40 mg;放疗采用三维适形定位,总剂量30～ 40 Gy;首次介入化疗后2个月采用绿激光行肿瘤汽化手术. 结果 放化疗后所有患者肿瘤明显坏死、缩小,5例肿瘤消失.激光治疗后随访3～43个月,2例复发,行再次绿激光汽化.2例死于脑血管意外.结论 动脉介入化疗、适形放疗联合绿激光治疗浸润性膀胱癌安全,疗效确实,对于老年、合并症多的患者或不愿接受膀胱全切的患者,是一个很好的选择.

Objective To evaluate the efficacy of bladder preservation treatment by combining intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization for muscle-invasive bladder cancer.Methods A total of 16 patients （13 males and 3 females; mean age,74 years; age range,68-86 years） with muscle-invasive bladder cancer underwent bladder preservation treatment,who refused or could not tolerate the radical cystectomy （11 cases with cardiovascular and cerebrovascular disease,3 cases with severe chronic obstructive pulmonary disease and other 2 cases refused radical cystectomy as initial therapeutic option）.The tumor stages were T2（9 cases）,T3（7 cases） and tumor grades were G1（3 cases）,G2（10 cases） and G3（3 cases）.The mean diameter of tumor was 3.5 cm （range from 3 cm to 6 cm）.They received intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization.The chemotherapy regimen consisted of cisplatin 80 mg and pirarubicin 40 mg.The average dose of radiotherapy was 30-40 Gy.Results After intraarterial chemotherapy and three dimensional conformal radiotherapy,all the tumors were necrosis and dwindled significantly and 5 patients showed a complete response.The patients were follow up for 3-43 months after transurethral photoselective vaporization of the residual tumor.Recurrent non-muscle invasive tumors were found in 2 patients and were treated transurethrally.Overall,2 patients died of cerebrovascular accident.Conclusion Combination of intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization is safe and effective for the treatment of muscle-invasive bladder cancer.