调强放疗与同步吉西他滨化疗加吡柔比星热灌注化疗治疗老年晚期膀胱癌的近期疗效及预后分析

The short-term efficacy and prognosis analysis of intensity-modulated radiotherapy with synchronous chemotherapy of gemcitabine plus pirarubicin hyperthermic perfusion chemotherapy in the treatment of elderly patients with advanced bladder cancer

目的探讨调强放疗与同步吉西他滨化疗加吡柔比星热灌注化疗治疗老年晚期膀胱癌的近期疗效及预后分析。方法回顾性分析118例晚期膀胱癌患者的临床资料,根据治疗方案的不同将患者分为对照组和观察组,每组59例。对照组患者采取单用调强放疗方案进行治疗,观察组患者采取调强放疗与同步吉西他滨化疗加吡柔比星热灌注化疗进行治疗。比较并分析两组患者的近期疗效和不良反应发生情况,并分析其预后生存影响因素。结果治疗结束后1个月,观察组患者的总有效率(RR)和疾病控制率(DCR)均高于对照组患者,差异均有统计学意义(P﹤0.05);两组患者的不良反应总发生率比较,差异无统计学意义(P﹥0.05),且均未发生严重4级不良反应;观察组患者的中位总生存期(OS)为18.58个月(95%CI:16.55~20.59个月),对照组患者的中位OS为14.23个月(95%CI:12.16~16.29个月),观察组患者的中位OS长于对照组患者(P=0.042)。Cox多元逐步回归分析结果显示:组织学分级为中低分化、有膀胱周围淋巴结转移、肿瘤直径大是影响老年晚期膀胱癌患者预后的独立危险因素(P﹤0.05)。结论调强放疗与同步吉西他滨化疗联合吡柔比星热灌注化疗治疗老年晚期膀胱癌患者的疗效较好,可有效提高患者的近期疗效,且未发生严重4级不良反应,可为治疗老年晚期膀胱癌提供新的治疗方案。

Objective To investigate the short-term efficacy and prognosis of intensity-modulated radiotherapy（IMRT） combined with gemcitabine chemotherapy plus pirarubicin hyperthermic perfusion chemotherapy in the treatment of elderly patients with advanced bladder cancer. Method The clinical data of 118 patients with advanced bladder cancer were retrospectively analyzed and assigned as study group and control group, according to respective different therapies administered, each included 59 patients. The control group was treated with IMRT alone, while the study group was given IMRT in combination with synchronous gemcitabine plus pirarubicin hyperthermic perfusion chemotherapy.The short-term efficacy and occurrence of adverse reactions in the two groups were compared and analyzed, and the prognostic factors of survival were investigated. Result The overall response rate（RR） and the disease control rate（DSR） of the study group were higher than those of the control group in 1 month after treatment, with significant difference observed（P〈0.05）. The incidence of adverse reactions in the two groups was similar, the difference was of no statistical significance（P〉0.05）, and so did the overall incidence of adverse reactions between the two groups（P〉0.05）, none had any case of serious adverse events at grade four; in study group, the median overall survival（OS） was 18.58 months（95%CI：16.55-20.59）, while that of control group was 14.23 months（95%CI： 12.16-16.29）, so and median OS was better in study group compared with control group（P=0.042）. Multivariate stepwise Cox regression analysis showed that, poor or moderate histological grading, with lymph node metastasis near the bladder, and large tumor diameter were independent prognostic risk factors in elderly patients with advanced bladder cancer（P〈0.05）. Conclusion IMRT and gemcitabine combined with pirarubicin hyperthermic perfusion chemotherapy is effective in the treatment of elderly patients with advanced bladder cancer, the combined therapy can effectively improve the short-term efficacy, with no serious adverse reaction of grade four, which is a potentially applicable therapy for elderly patients with advanced bladder cancer.