Long-term single-institute experience with trimodal bladder-preserving therapy with proton beam therapy for muscle-invasive bladder cancer
Long-term single-institute experience with trimodal bladder-preserving therapy with proton beam therapy for muscle-invasive bladder cancer
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三模式膀胱保留疗法联合质子束疗法治疗肌层浸润性膀胱癌的长期单机构经验
DOI：
10.1093/jjco/hyw151
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发表时间：
2017
期刊：
影响因子：
2.4
通讯作者：
Nishiyama H
中科院分区：
文献类型：
--
作者：
Takaoka EI;Miyazaki J;Ishikawa H;Kawai K;Kimura T;Ishitsuka R;Kojima T;Kanuma R;Takizawa D;Okumura T;Sakurai H;Nishiyama H
我们回顾性地阐明了肿瘤学结果，预后因素和毒性质子束治疗在三模式膀胱保留治疗肌层浸润性膀胱癌在我们的institution.MethodsFrom 1990年至2015年，70例cT 2 - 3 N 0 M0肌层浸润性膀胱癌患者接受了三模式膀胱保留治疗，包括膀胱肿瘤的最大经尿道切除术，小骨盆光子照射，动脉内化疗和质子束治疗。分析总生存率、无进展生存率、至疾病进展时间、疾病进展预测因素及毒副反应。进展被定义为当肌肉浸润性复发，远处转移或上尿路复发observed.ResultsThe患者的中位年龄为65（范围36-85）岁。中位随访期为3.4（范围0.6-19.5）年。5年累积总生存率、无进展生存率和疾病进展时间分别为82%、77%和82%。在单变量和多变量分析中，肿瘤多样性和肿瘤大小（≥5 cm）是与进展相关的显著和独立因素（风险比3.5，95%置信区间1.1-12;风险比5.0，95%置信区间1.3-17;P均< 0.05）。至于毒性，26例（18%）患者发生3-4级急性血液学毒性，2例（3%）患者发生3级晚期泌尿生殖系统毒性。没有病人停止治疗，由于急性toxics.ConclusionsOur膀胱保留治疗质子束治疗耐受性良好，并取得了良好的死亡率。肿瘤多样性和肿瘤大小是进展的重要危险因素。我们的研究结果表明，这种疗法可以成为选定的肌肉浸润性膀胱癌患者的有效治疗选择。
ObjectiveWe retrospectively elucidated the oncological outcomes, prognostic factors and toxicities of proton beam therapy in trimodal bladder-preserving therapy for muscle-invasive bladder cancer at our institution.MethodsFrom 1990 to 2015, 70 patients with cT2–3N0M0 muscle-invasive bladder cancer underwent trimodal bladder-preserving therapy consisting of maximal transurethral resection of the bladder tumor, small pelvis photon irradiation, intra-arterial chemotherapy and proton beam therapy. The overall survival rate, progression-free survival rate, time to progression, predictive factors for progression and toxicities were analyzed. Progression was defined as when muscle-invasive recurrence, distant metastasis or upper urinary tract recurrence was observed.ResultsThe patients’ median age was 65 (range 36–85) years. The median follow-up period was 3.4 (range 0.6–19.5) years. The 5-year cumulative overall survival rate, progression-free survival rate and time to progression rate were 82%, 77%, and 82%, respectively. In univariate and multivariate analyses, tumor multiplicity and tumor size (≥5 cm) were significant and independent factors associated with progression (hazard ratio 3.5, 95% confidence interval 1.1–12; hazard ratio 5.0, 95% confidence interval 1.3–17;P< 0.05 for all). As for toxicity, 26 (18%) patients had grade 3–4 acute hematologic toxicities and 2 (3%) patients had grade 3 late genitourinary toxicity. No patient had to discontinue the treatment due to acute toxicity.ConclusionsOur bladder-preserving therapy with proton beam therapy was well tolerated and achieved a favorable mortality rate. Tumor multiplicity and tumor size were important risk factors for progression. Our findings indicate that this therapy can be an effective treatment option for selected muscle-invasive bladder cancer patients.