COMBINED MODALITY PROGRAM WITH POSSIBLE ORGAN PRESERVATION FOR INVASIVE BLADDER-CARCINOMA - RESULTS OF RTOG PROTOCOL 85-12
COMBINED MODALITY PROGRAM WITH POSSIBLE ORGAN PRESERVATION FOR INVASIVE BLADDER-CARCINOMA - RESULTS OF RTOG PROTOCOL 85-12
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DOI：
10.1016/0360-3016(93)90306-g
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发表时间：
1993-04-02
影响因子：
7
通讯作者：
HAMMOND, E
中科院分区：
文献类型：
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作者：
TESTER, W;PORTER, A;HAMMOND, E
目的：这项II期研究旨在测试顺铂-放疗同步治疗浸润性膀胱癌的耐受性和有效性。目的是确定毒性，完全缓解率，膀胱保存率，和survival.Methods和材料：浸润性膀胱癌，临床分期T2-4，NO-2或NX，MO患者进行盆腔放疗40戈伊，4周，顺铂100 mg/m2的第1和22天。完全反应者给予额外的24戈伊膀胱升压加第三剂量的顺铂; 40戈伊后残留肿瘤的患者被分配根治cycliver.Results：顺铂和40戈伊后的完全缓解率为31/47（66%）。急性毒性是可接受的，只有两名患者没有完成诱导治疗。低分化肿瘤患者更有可能达到完全缓解。在完全可评估的患者中，28/42（67%）在诱导治疗后达到完全缓解，11例持续缓解，8例复发，膀胱是唯一的失败部位。8例中5例复发，均为非侵袭性肿瘤。在14名未能达到完全缓解的患者中，只有3名患者保持无病状态。未达到中位生存期，报告了17/42（19/48）例死亡。精算生存率为64%，在3 years.Conclusion：这种联合顺铂放疗方案是中度耐受性良好，并与肿瘤清除率在66%的患者治疗。孤立性膀胱复发合并浸润性癌并不常见。如果综合治疗是为了实现膀胱癌患者的疾病控制和器官保护，则需要更好地定义预处理选择标准。
Purpose: This Phase II study was designed to test the tolerance and effectiveness of concurrent cisplatin-radiotherapy in the treatment of invasive bladder cancer. Objectives were to determine toxicity, complete response rate, bladder preservation rate, and survival.Methods and Materials: Patients with invasive bladder cancer, clinical Stages T2-4, NO-2 or NX, MO were treated with pelvic radiotherapy 40 Gy in 4 weeks and cisplatin 100 mg/m2 on days 1 and 22. Complete responders were given an additional 24 Gy bladder boost plus a third dose of cisplatin; patients with residual tumor after 40 Gy were assigned radical cystectomy.Results: The complete remission rate following cisplatin and 40 Gy for evaluable cases was 31/47 (66%). Acute toxicity was acceptable with only two patients not completing induction therapy. Patients with poorly differentiated tumors were more likely to achieve complete remission. Of fully evaluable patients, 28/42 (67%) achieved complete remission with induction therapy, 11 remain continuously in remission, and eight have relapsed with bladder as the only site of failure. Five of these eight cases relapsed with noninvasive tumor. Of the 14 patients who failed to achieve complete remission, only three remain disease-free. Median survival is not reached, with 17/42 (19/48) deaths reported. Actuarial survival is 64% at 3 years.Conclusion: This combined cisplatin-radiotherapy regimen was moderately well-tolerated and associated with tumor clearance in 66% of patients treated. Isolated bladder recurrences with invasive carcinoma are infrequent. Better definition of pretreatment selection criteria is needed if combined modality treatment is to achieve disease control and organ preservation for patients with bladder cancer.