T2和T3期膀胱癌术后放射治疗及膀胱内灌注化疗疗效分析

Postoperative radiotherapy combined with intravesical chemotherapy for T2/T3 bladder cancer

目的 分析T2、T3期膀胱移行细胞癌行部分膀胱切除术后放射治疗及膀胱内灌注治疗疗效。方法 回顾性分析本院 93例膀胱癌行部分膀胱切除术后放射 +化疗疗效 ,其中 5 8例接受放射治疗及灌注化疗 (放 +灌组 ) ,35例仅接受膀胱内灌注化疗 (灌注组 )。放射治疗采用 8或 18MVX射线 ,照射剂量为 5 0～ 6 0Gy。膀胱内灌注采用噻替哌或卡介苗 ,前者 5 0～ 6 0mg/次 ,2次 /周 ,共 6次 ;后者 0 .5mg/次 ,1次 /周 ,共 3次。结果 放 +灌组和灌注组 3年局部控制率分别为 6 8.6 %、48.2 %(χ2 =4.0 8,P =0 .0 44 ) ;1、3、5年生存率分别为 94.7%、70 .7%、49.5 %和 87.2 %、5 9.9%、35 .7% (χ2 =1.77,P =0 .184) ;放 +灌组生存 5年者有 78.6 %保存膀胱。放 +灌组放射反应大 ,但患者都能耐受。结论 T2、T3期膀胱移行细胞癌行部分膀胱切除术后放射治疗 +膀胱内灌注化疗可以降低局部复发。

Objective To compare the result of T2/T3 transitional cell carcinoma (TCC) of the urinary bladder after segmental cystectomy, treated by postoperative radiation plus intravesical chemotherapy and postoperative intravesical chemotherapy alone.Methods From 1985 to Dec.1995 patients with T2/T3 TCC bladder cancer who had been treated by segmental cystectomy were eligible for this retrospective analysis. Fifty-eight patients received postoperative radiotherapy plus intravesical chemotherapy (RT+IVC) and 35 patients were given postoperative intravesical chemotherapy (IVC) with thio-TEPA or calmette-Gue'rin bacilli (BCG). For radiation,8 or 18 ?MV X-ray was given with total dose of 50-60 ?Gy. Vesicoclysis was performed on 50-60 mg thio-TEPA twice per week and 0.5 mg BCG per week.Results The 3-year local control rates of RT+IVC and IVC groups were 68.6% and 48.2% showing a difference statistically significant (χ 2=4.08,P=0.044).The 3- and 5-year survival rates of RT+IVC and IVC groups were 70.7%,49.5% and 59.9%,35.7% ,showing no significant difference (χ 2=1.77,P=0.184). Among the 5 year survivors of the RT+IVC patients, 78.6% had their bladder preserved. Though untoward radiation reactions were severer, they were tolerated well.Conclusions Combined radiation therapy plus intravesical chemotherapy is indicated for T2/T3 bladder cancer after segmental cystectomy. Multimodality therapy is more favored to improve both the local control and the possibility of preserving the bladder.