膀胱癌患者保留膀胱术后的放射治疗

Radiotherapy in the patients with bladder carcinoma treated by conservative surgery

背景与目的:全膀胱切除术被认为是肿瘤侵犯肌层的标准治疗方法,对于不愿或由于其他情况不能接受全膀胱切除术的患者,作为替代手段,综合治疗保留膀胱的方法的研究已经有数十年。综合治疗措施包括经尿道切除膀胱肿瘤、放射治疗和化疗。本文总结膀胱癌保留膀胱术后放射治疗的疗效和毒副反应,以评价和分析影响因素。方法:对21例病理诊断为膀胱癌的患者进行回顾性分析,其中T2期15例,T3期5例,T4期1例。2例有淋巴结转移。病理分类为:移形细胞癌16例,腺癌4例,移形细胞癌伴鳞癌1例。所有患者均接受了放射治疗,采用常规分割,照射剂量最低49.2 Gy,最高69.9 Gy,中位54.5 Gy。局控及生存分析用Kap lan-M e ier法及Logrank检验。结果:中位随访期32个月,1、3、5年生存率分别为90.5%,47.1%和36.7%,1、3、5年局部控制率分别为95.0%,62.4%和47.5%。16例死亡。单因素分析显示只有采用先大野照射后小野照射者其生存与单纯小野照射者有显著性差异(χ2=5.36,P=0.02)。结论:综合治疗膀胱癌可以取得较好的效果,可作为不适于手术全切除患者的一种选择方法。放射治疗在膀胱癌综合治疗的作用和地位需要随机研究来进一步探讨。

Background and purpose： Radical cystectomy is viewed as the standard treatment for bladder carcinoma, but organ preservation has been attempted for patients with muscle-invasive bladder carcinoma over the past decades as an alternative to radical cysteetomy, The majority of studies included transurethral resection of bladder tumor（ TURB）, radiotherapy , and chemotherapy, as a feasible and safe organ-sparing approach with the similar outcome to radical cystectomy, The current study evaluated the outcomes and complications of the radiation therapy for the patients with bladder cancer, and prognosis factors had been analyzed. Methods： We retrospectively analyzed 21 patients with bladder cancer, The clinical stages of the patients were 15 with T2; 5 with T3 and 2 with T4. 2 of them were lymph node-posltlve, 16 of patients were pathologically proved as transitional cell carcinoma, 4 as adenocarcinoma and 1 as transitional cell carcinoma plus squamous cell carcinoma, Con＇,entional fractionatlon radiotherapy was given at a median dose of 54.5Gy （ranged 49.2-69.9 Gy） after surgery, Kaplan-Meier method and Logrank method were used for the statistical analysis, Results： Median followup was 32 months. The overall survivals at 1 year, 3 years and 5 years were 90, 5%, 47, 1%, and 36.7% respectively. The local disease free rates were 95.0%, 62.4%, and 47, 5% respectively. 15 of 16 patients＇deaths were related to the tumor, In univariate analysis, only small field irradiation was found as a prognosis factor in survival（ x^2 =5.36, P =0, 02）. Conclusions： Combined treatment appears to provide high response rates and can be offered as an alternative option to radi- cal cystectomy for selected patients who refuse or are unsuitable for surgery. A large number of patients, muhicenter, prospective randomized trial wouhl be desirable to evaluate the role of radiotherapy in the muhi-modality treatment of bladder cancer.