新辅助介入化疗后经尿道切除治疗浸润性膀胱癌

Combinations of neoadjuvant chemotherapy and transurethral resection for invasive bladder cancer

目的:探讨新辅助介入化疗结合经尿道切除治疗浸润性膀胱癌的疗效。方法:对15例有膀胱全切指征而患者无法耐受或不愿接受膀胱全切手术的浸润性膀胱移行细胞癌患者进行保留膀胱的手术治疗。采用新辅助动脉介入化疗后经尿道切除治疗,经髂内动脉灌注的化疗药物为健择1.0g/m2。结果:经新辅助动脉介入化疗后,完全缓解(CR)1例(6.7%),部分缓解(PR)14例(93.3%),膀胱癌瘤体明显缩小,缩小的癌灶经尿道电切或钬激光均得以顺利切除,患者膀胱得以保留。所有病例定期随访,平均随访22.4个月。肿瘤复发5例(33.3%),对复发肿瘤再次行经尿道切除术或化疗、放疗。结论:术前动脉化疗可使多数浸润性膀胱癌降期,使部分患者接受保留膀胱手术。临床初步的观察结果提示疗效良好,且患者保留膀胱功能,获得了较好的生活质量。

Objective：To evaluate the effect of internal iliac arterial chemotherapy （IIAC） followed by transurethral resection （TURbt） for invasive bladder cancer. Methods：Fifteen patients who were unfit for or unwilling to accept radical cystectomy were treated by IIAC with gemcitabine 1 g/m^2 and THP 40 mg. These patients had muscle invasive transitional cell carcinoma of bladder. One month later, all patients were performed TURbt. Results; After IIAC, one patient （6.67 % ） showed a complete remission and 14 patients （93.33 % ） showed partial remission. TURbt was performed for residual tumors. All cases were followed up, with a median follow-up of 22.4 months. Five cases had local recurrence or distant metastasis. Recurrent tumors were treated with TURbt or systematic chemotherapy and radiotherapy. Conclusions： IIAC, as neoadjuvant chemotherapy, has the possibility of down-staging the cancer, which provides the chance of bladderpreserving operations for invasive bladder cancer. The combination of neoadjuvant chemotherapy and TURbt for invasive bladder cancer is a feasible and promising treatment.