The updated outcomes of bladder-preserving trimodal therapy using a real-time tumor-tracking radiotherapy system for patients with muscle-invasive bladder cancer
The updated outcomes of bladder-preserving trimodal therapy using a real-time tumor-tracking radiotherapy system for patients with muscle-invasive bladder cancer
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DOI：
10.1093/jjco/hyz211
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发表时间：
2020-05-01
影响因子：
2.4
通讯作者：
Shinohara，Nobuo
中科院分区：
文献类型：
--
作者：
Miyata，Haruka;Osawa，Takahiro;Shinohara，Nobuo
目的保留膀胱三模式疗法被认为是肌层浸润性膀胱癌有前景的替代疗法。我们报告了使用我们的治疗方案治疗的肌层浸润性膀胱癌患者的最新结果，该方案涉及通过实时肿瘤跟踪放射治疗系统进行放射治疗。方法纳入了 1998 年至 2016 年间诊断为 T2-T4N0M0 膀胱癌且患有临床上无法手术的疾病或拒绝接受手术的 38 名患者。治疗方案包括最大程度的经尿道切除术，然后进行全膀胱放射治疗（40 Gy）。对肾功能良好的患者进行基于奈达铂的同步化疗。在第一次评估时（通过经尿道切除肿瘤床），将基准标记通过内窥镜插入肿瘤周围的膀胱壁中。使用实时肿瘤跟踪放射治疗系统进行了 25 Gy 的加强剂量。第二次评估（通过经尿道肿瘤床切除术）在治疗开始 6 个月后进行。采用 Kaplan-Meier 法和 Cox 风险分析来分析总生存期和癌症特异性生存期。结果中位随访时间为 28 个月（范围：3-161 个月）。 5年和10年总生存率分别为54.9%和41.2%。在第一次和第二次评估中，分别有 25 名 (65.8%) 和 20 名 (74.1%) 患者对放化疗取得完全缓解。在单变量和多变量分析中，发现体能状态与总生存率 [P= 0.03，风险比：3.48，95% 置信区间：1.15–10.6] 和癌症特异性生存率 [P= 0.02，风险比：4.57，95% 置信区间：1.32–16.9] 显着相关，并且性别与癌症特异性生存率显着相关[P= 0.03，风险比：3.07，95% 置信区间：1.09–8.30]。结论我们的膀胱保留三模式治疗方案涉及使用实时肿瘤跟踪放射治疗系统，产生了可接受的总体生存率。对于身体上不适合或不想接受膀胱切除术的患者来说，这种疗法是一种合理的选择。
ObjectiveBladder-preserving trimodal therapy is recognized as a promising alternative treatment for muscle-invasive bladder cancer. We report the updated outcomes of muscle-invasive bladder cancer patients that were treated using our treatment protocol, which involves radiotherapy delivered with a real-time tumor-tracking radiotherapy system.MethodsThirty-eight patients who were diagnosed with T2-T4N0M0 bladder cancer between 1998 and 2016 and had clinically inoperable disease or refused to undergo surgery were enrolled. The treatment protocol included maximal transurethral resection followed by whole-bladder radiotherapy (40 Gy). Concurrent nedaplatin-based chemotherapy was administered to patients with adequate renal function. At the time of the first evaluation (via transurethral resection of the tumor bed), fiducial markers were endoscopically inserted into the bladder wall around the tumor. A boost of 25 Gy was administered using the real-time tumor-tracking radiotherapy system. The second evaluation (via transurethral resection of the tumor bed) was performed 6 months after the start of treatment. The Kaplan–Meier method and Cox hazards analysis were used to analyze overall survival and cancer-specific survival.ResultsThe median duration of the follow-up period was 28 months (range: 3–161 months). The 5- and 10-year overall survival rates were 54.9 and 41.2%, respectively. Twenty-five (65.8%) and twenty (74.1%) patients had achieved complete responses to chemoradiation at the first and second evaluations, respectively. In univariate and multivariate analyses, performance status was found to be significantly associated with overall survival [P= 0.03, hazard ratio: 3.48, 95% confidence interval: 1.15–10.6] and cancer-specific survival [P= 0.02, hazard ratio: 4.57, 95% confidence interval: 1.32–16.9], and sex was shown to be significantly associated with cancer-specific survival [P= 0.03, hazard ratio: 3.07, 95% confidence interval: 1.09–8.30].ConclusionsOur bladder-preserving trimodal therapy protocol, which involves the use of a real-time tumor-tracking radiotherapy system, produced an acceptable overall survival rate. This therapy is a reasonable alternative for patients that are medically unfit for or do not want to undergo cystectomy.