放射治疗在肌层浸润性膀胱癌治疗中的应用

根治性膀胱切除术仍是高分期、肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的标准治疗手段,但因手术创伤大,生活方式改变,使患者接受困难。经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TUR-BT)、辅助放疗/化疗保留膀胱的综合治疗广受关注。术前放疗能够降低T3期患者的病死率,在总生存率(overall survival,OS)、无病生存率(disease-free survival,DFS)方面都有获益;术后放疗推荐为有高危因素患者的辅助治疗;采取TUR-BT尽可能全切肿瘤后辅助放疗和化疗的三联治疗能够取得与根治性膀胱切除术相似的疗效。放疗是能够迅速减轻膀胱肿瘤引起出血等症状的有效治疗手段。

全膀胱切除术后及术后复发的放射治疗

目的研究放射治疗对膀胱癌病人全膀胱切除术后以及术后复发的疗效。方法对17例膀胱癌病人进行放射治疗,平均年龄63岁(50-77岁)。10例为全膀胱切除术后复发,7例为全膀胱切除术后行放射治疗。所有病人分期均按术后病理分期,T2期3例,T3期3例,T4期11例。照射总剂量为44.8Gy-65.5Gy,中位52.3Gy。结果中位随访期19个月,总的1、2年生存率分别为81.9%和31.5%。17例中死亡15例,13例死于肿瘤,其中7例死于治疗后第二年。年龄是唯一影响总生存率的因素,≤63岁的病人其1、2年生存率分别为88.9%和64.5%,>63岁的病人其1年生存率为75%,无1例存活超过2年(P=0.02)。结论全膀胱切除术后以及术后复发的治疗,其预后较差,需要有大样本研究或随机研究对其治疗以及放射治疗的作用进一步研究。

膀胱癌患者保留膀胱术后的放射治疗

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。

综合治疗预防膀胱癌保存膀胱术后复发

目的探讨放射治疗+化疗预防肌层侵犯的浸润性膀胱癌保存膀胱术后复发的疗效。方法23例肌层侵犯的浸润性膀胱移行细胞癌保存膀胱术后在丝裂霉素规则膀胱灌注化疗的基础上行放射治疗(研究组),照射平均剂量为52.5Gy。以29例同期同样病变行保存膀胱术后单纯丝裂霉素规则膀胱灌注化疗的为对照(对照组)。结果研究组除2例因放射性膀胱炎分别中断3d和1周后继续治疗外,其余均按计划完成治疗。所有病例随访3a以上,平均随访41.6个月。研究组和对照组3a盆腔复发率分别为18.8%和44.8%(P=0.026);3a远地转移率分别为18.2%和24.1%(P=0.437);3a生存率分别为81.8%和86.2%(P=0.670)。结论保存膀胱术后放疗+化疗治疗能有效降低肌层侵犯浸润性膀胱癌盆腔复发率,是膀胱癌保存膀胱术后理想的辅助治疗。

109例膀胱癌三维适形放疗临床分析

目的回顾分析109例膀胱癌三维适形放疗疗效、副作用及预后因素。方法近12年内接受三维适形放疗的原发膀胱癌患者109例，年龄41—94岁（中位值68岁）。4例未行手术治疗，105例行保留膀胱手术。根据2003年UICC分期标准分期，T1、T2a、T2b、T3b、T4期分别为29、27、33、15、2、3例。N0期92例，N1期7例，N分期不详10例。所有患者均接受了常规分割三维适形放疗，总剂量39．3～62．2Gy（中位549．6Gy），其中57例采用全膀胱加局部瘤区野中野照射，局部瘤区单次剂量为1．9～2．2Gy（中位值2．0Gy）。结果随访2～144个月（中位值36个月），总随访率为98％，其中1、3、5年随访率分别为95％、53％、32％。1、3、5年局部控制率分别为63％、47％、42％，总生存率分别为80％、48％、37％。多因素分析结果表明总生存率的独立预后因素为T分期、病理类型、N分期和不同放疗方式。膀胱局部控制率的独立预后因素为KPS评分、不同手术方式以及放疗与手术间隔时间。全组中肿瘤相关死亡33例。放疗后膀胱内复发42例，盆腔或腹腔淋巴结转移22例。根据RTOG分级标准，急性泌尿系统反应1级22％，2级59％，3级12％，4级1％；晚期泌尿系统反应1级29％，2级28％，3级2％，4级1％。结论三维适形放疗在膀胱癌治疗中特别是全膀胱加局部瘤区野中野照射方式可取得较好临床效果，副作用在可接受范围，可作为保留膀胱功能手术患者的一种治疗方法。

Combined modality therapy following bladder conservation surgery for bladder cancers

OBJECTIVE: To analyze the efficacy of recurrence prophylaxis using radiation and chemotherapy following bladder conservation surgery for muscle invasive bladder cancer. METHODS: 23 patients with muscle invasive bladder cancer were treated with radiotherapy combined with bladder mitomycin infusion after bladder conservation surgery (study group). Radiotherapy was given using an external beam at an average dose of 5148 +/- 462 cGy with conventional fractionation. For comparison, 29 similar patients treated with postoperative bladder mitomycin infusion without radiation served as control (control group). All patients were followed up for more than 3 years, an average of 41.6 months (36 - 60 months). RESULTS: The 3-year pelvic recurrent rate of muscle invasive bladder cancer was 17.4% in the study group and 44.8% (P = 0.036) in the control group. The 3-year distant metastasis rates were 17.4% and 24.1%, respectively (P = 0.554). The 3-year overall survival rates were 81.8% and 86.2%, respectively (P = 0.670). Two patients from the study group had their treatment interrupted, one for 3 days and the other for one week due to acute cystitis, while the rest of the patients were able to complete the treatment according to schedule. CONCLUSION: Radiotherapy plus chemotherapy after bladder conservation surgery for muscle invasive bladder cancer can decrease the rate of pelvic recurrence effectively and be used as a realistic adjuvant treatment.

Combined modality therapy following bladder conservation surgery for bladder cancers

To analyze the efficacy of recurrence prophylaxis using radiation and chemotherapy following bladder conservation surgery for muscle invasive bladder cancer Methods 23 patients with muscle invasive bladder cancer were treated with radiotherapy combined with bladder mitomycin infusion after bladder conservation surgery (study group) Radiotherapy was given using an external beam at an average dose of 5148±462 cGy with conventional fractionation For comparison, 29 similar patients treated with postoperative bladder mitomycin infusion without radiation served as control (control group) All patients were followed up for more than 3 years, an average of 41 6 months (36-60 months) Results The 3 year pelvic recurrent rate of muscle invasive bladder cancer was 17 4% in the study group and 44 8% ( P =0 036) in the control group The 3 year distant metastasis rates were 17 4% and 24 1%, respectively ( P =0 554) The 3 year overall survival rates were 81 8% and 86 2%, respectively ( P =0 670) Two patients from the study group had their treatment interrupted, one for 3 days and the other for one week due to acute cystitis, while the rest of the patients were able to complete the treatment according to schedule Conclusion Radiotherapy plus chemotherapy after bladder conservation surgery for muscle invasive bladder cancer can decrease the rate of pelvic recurrence effectively and be used as a realistic adjuvant treatment