顺铂为主的新辅助化疗方案治疗进展性膀胱癌的疗效分析

Cisplatin-based neoadjuvant chemotherapy in the treatment of patients with advanced bladder cancer

目的探讨顺铂为主的新辅助联合化疗方案治疗进展性膀胱癌的临床疗效及毒副作用。方法 54例局部进展性膀胱癌患者中,其中22例术前予MVAC新辅助化疗方案(甲氨喋呤30 mg/m2,第2、15、22天;长春花碱3 mg/m2第2、15、22天;阿霉素30 mg/m2,第2天;和顺铂70 mg/m2第2天)治疗;18例术前接受GC新辅助化疗方案(吉西他滨1000 mg/m2第l,8,15天;顺铂70 mg/m2第2天)治疗;14例患者术前予以DC新辅助化疗(多西紫杉醇75 mg/m2,第1天和顺铂75 mg/m2第2天)方案。所有患者均在术前接受3个周期的新辅助化疗后接受膀胱切术。结果 54例患者中,治疗后完全缓解10例,部分缓解17例,稳定18例,进展9例,有效率为50%(27/54)。中位疾病进展时间为10.1个月,中位生存时间为14.8个月。主要毒副作用为贫血和白细胞减少,其中Ⅲ～Ⅳ度贫血发生率占48.1%,中性粒细胞减少发生率分别为46.3%。结论 顺铂为主的联合化疗方案治疗进展性膀胱癌疗效确切,毒性反应可耐受。

Objective To investigate the efficacy and toxicity of cisplatin-based combination chemotherapy in patients with advanced bladder cancer.Methods Of the fifty-four patients with advanced bladder cancer,22 patients received neoadjuvant chemotherapy with the regimen of MVAC（methotrexate 30 mg/m2,2 d-1,15 d-1,22 d-1;vinblastine 3 mg/m2,2d-1,15d-1,22d-1;adriamycin 30 mg/m2,2d-1;and cisplatin 70 mg/m2,2d-1）;22 patients received neoadjuvant chemotherapy with the regimen of GC（gemcitabine 1000 mg/m2,1d-1,8d-1,15d-1 and cisplatin 70 mg/m2,2d-1）;14 patients received neoadjuvant chemotherapy with the regimen of DC（docetaxel 75 mg/m2,1d-1,8d-1,15d-1 and cisplatin 70 mg/m2,2d-1）.All patients received neoadjuvant chemotherapy three cycles.Results There were 10 patients CR,17 patients PR,18 patients SD,and 9 patients PD among 54 patients after treatment by neoadjuvant chemotherapy plus cystectomy,the response rate was 50%（27/54）.The median time to progression（TTP） was 10.1 months,and median survival time（MST） was 14.8 months.The major toxicity was anemia（48.1% in grade Ⅲ～Ⅳ） and leukopenia（46.3% in grade Ⅲ～Ⅳ）.Conclusion Better clinical effects have been achieved in the therapy of advanced bladder cancer by cisplatin-based neoadjuvant chemotherapy plus cystectomy and toxicities are tolerable.