Radiotherapy for stage T3b transitional cell carcinoma of the bladder.
Radiotherapy for stage T3b transitional cell carcinoma of the bladder.
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T3b 期膀胱移行细胞癌的放射治疗。
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
G. Zagars
中科院分区：
文献类型：
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作者：
A. Pollack;G. Zagars
放射治疗在临床T3b期膀胱移行细胞癌治疗中的作用是有争议的。选择范围从单纯的确定性放疗，到术前放疗和化疗，再到化疗和放疗以保留膀胱。我们的数据显示，明确放疗后的长期局部控制率仅为27%，在这种情况下，由于局部区域失败而导致的死亡率为43%。因此，确定性放疗仅用于被认为不适合手术和化疗的患者。术前放疗（PREOP）已经在一些随机系列研究中进行了研究，所有这些研究都未能确定与单纯根治性环磷酰胺（CYST）治疗相比患者结局的改善。然而，这些研究受到了批评，主要是因为不良的患者招募和可用于分析的患者数量少。在MD安德森癌症中心接受治疗的患者的回顾性审查表明，与CYST相比，PREOP的局部控制上级。一项关于局部控制对接受CYST治疗的患者远处转移率影响的分析显示，局部控制是远处转移和生存的独立相关因素。因此，术前放射治疗可能是有益的患者与晚期肌肉浸润性膀胱癌，确保局部控制和减少远处转移率的结果。T3b期患者膀胱保留的成功取决于选择放射敏感性肿瘤患者的能力。为此，在接受PREOP治疗的患者中研究肿瘤p53和pRB的免疫组织化学染色状态。异常pRB表达与放射反应密切相关，而p53表达改变与高无远处转移和总生存率相关。这两个分子标记是互补的，并显示出在促进膀胱保存晚期患者的选择的承诺。
The role of radiotherapy for the treatment of clinical stage T3b transitional cell carcinoma of the bladder is controversial. The options range from definitive radiotherapy alone, to preoperative radiotherapy and cystectomy, to chemotherapy and radiation for bladder preservation. Our data show that long-term local control after definitive radiotherapy is only 27% and that death attributable to local-regional failure in this setting is 43%. Thus, definitive radiotherapy is only used in patients who are considered poor candidates for surgical and chemotherapy procedures. Preoperative radiotherapy (PREOP) has been studied in a number of randomized series, all of which failed to establish an improvement in patient outcome over those treated with radical cystectomy alone (CYST). However, these studies are subject to criticism, mostly because of poor patient accrual and low numbers of patients available for the analyses. A retrospective review of patients treated at MD Anderson Cancer Center indicates that local control is superior with PREOP as compared with CYST. An analysis of the impact of local control on distant metastasis rates in patients treated with CYST showed that local control was an independent correlate of distant metastasis and survival. Thus, preoperative radiotherapy may be beneficial to patients with late-stage muscle-invasive bladder cancer by securing local control and reducing distant metastasis rates as a result. The success of bladder preservation for stage T3b patients rests with the ability to select patients with radiosensitive tumors. To this end, the immunohistochemical staining status of tumor p53 and pRB was investigated in patients treated with PREOP. Abnormal pRB expression was very strongly related to radiation response, whereas altered p53 expression was associated with high distant metastasis-free and overall survival rates. These two molecular markers were complementary and show promise in facilitating the selection of late-stage patients for bladder preservation.