Favorable outcome of preoperative low dose chemoradiotherapy against muscle-invasive bladder cancer
Favorable outcome of preoperative low dose chemoradiotherapy against muscle-invasive bladder cancer
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DOI：
10.1097/01.coc.0000037665.11701.22
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发表时间：
2003-10-01
影响因子：
2.6
通讯作者：
Kihara, K
中科院分区：
文献类型：
--
作者：
Kageyama, Y;Yokoyama, M;Kihara, K
为探讨术前小剂量放化疗的可行性，对50例T2 ~ T4期局限性肌层浸润性膀胱癌患者行顺铂（100 mg/体× 2个疗程）联合盆腔放疗（40戈伊）。在20例（40%）达到临床完全消退的患者中，11例孤立性肿瘤因高龄、患者状况差或不愿接受根治性手术而接受了部分切除。其余39例行根治性膀胱切除术（完全消退9例，部分消退30例）。所有病例中有18例（36%）达到病理TO反应（无残留肿瘤）。中位随访时间为19个月（范围2-59个月）。所有患者的估计3年无病生存率为75%，T0应答者为100%。32例病理性持续性肿瘤中8例局部复发（2例）或远处转移（6例）。所有接受膀胱部分切除术的11名患者（9名为T0缓解，2名为小残留肿瘤巢）在长达59个月的观察期内均无复发。低剂量放化疗与其他新辅助治疗方案一样有效，适用于高危患者。在临床完全消退的病例中，可通过部分膀胱切除术保留膀胱。
To investigate the feasibility of preoperative low-dose chemoradiotherapy, 50 patients with localized muscle-invasive bladder cancer (T2-T4) were treated with concurrent cisplatin (100 mg/body X 2 courses) and pelvic irradiation (40 Gy). Among 20 patients (40%) who achieved clinical complete regression, 11 with solitary tumor underwent partial cystectomy because of advanced age, poor condition of the patients, or a reluctance to have radical surgery. Radical cystectomy was carried out in the remaining 39 cases (complete regression 9, partial regression 30). Pathologic TO response (no residual tumor) was achieved in 18 (36%) of all the cases. Median follow-up was 19 months (range 2-59 months). Estimated 3-year disease-free survival was 75% for all patients and 100% for T0 responders. Local recurrence (2 patients) or distant metastasis (6 patients) developed in 8 of 32 patients with pathologic persistent tumor. All of the 11 patients (9 with T0 response and 2 with a small residual tumor nest) who underwent partial cystectomy were recurrence free for observation periods up to 59 months. Low-dose chemoradiotherapy is as effective as other neoadjuvant protocols and is applicable to high-risk patients. The bladder can be preserved by partial cystectomy in selected cases with clinical complete regression.