膀胱癌放疗疗效分析  

The efficacy of radiotherapy for muscle invasive bladder cancer and its associated factors analysis

作　　者：高俊俊 刘跃平 寿建忠 李晔雄 金晶 房辉 王淑莲 宋永文 陈波 亓姝楠 唐源 唐玉 李宁 卢宁宁 余子豪 Gao Junjun;Liu Yueping;Shou Jianzhong;Li Yexiong;Jin Jing;Fang Hui;Wang Shulian;Song Yongwen;Chen Bo;Qi Shunan;Tang Yuan;Tang Yu;Li Ning;Lu Ningning;Yu Zihao(Department of Urology,Department of Radiation Oncology,Cancer Hospital and Institute,National Cancer Center /National Clinical Research Center for Cancer,Chinese Academy of Medical Sciences and Peking Union Medical College,100021 Beijing.)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2018年第8期740-743,共4页Chinese Journal of Radiation Oncology

基　　金：中国癌症基金会北京希望马拉松专项基金资助项目（ZZ2017801）;国家重大研发计划资助（2016YFC0904600）

摘　　要：目的回顾分析局限于盆腔的肌壁浸润性膀胱癌放疗疗效及影响因素、膀胱功能保存情况及不良反应。方法自1999—2016年在我院接受放疗的肌壁浸润性膀胱癌患者45例（移行细胞癌41例）。全膀胱±盆腔淋巴引流区±局部补量放疗，膀胱中位剂量45Gy，肿瘤局部中位剂量56Gy，24例接受了同步化疗，14例接受了新辅助化疗．29例放疗前接受过经尿道膀胱肿瘤电切术。结果中位随访28个月（4～101月），3年总生存率为51％，同步化放疗、单纯放疗3年总生存率分别为64％、30％（P=0．001），有无新辅助化疗的3年总生存率分别为59％和47％（P=0．540），放疗前有无局部电切的3年总生存率分别为58％和43％（P=0．160），有无复发的3年生存率分别为20％和79％（P=0．001）。局部复发9例．远处转移14例，放疗后≥3个月肠道损伤发生率2级2例，泌尿道损伤发生率2级4例、3级2例。除7例因膀胱肿瘤未控或放疔损伤严重影响患者膀胱功能外，其余均保持了基本正常膀胱功能。结论盆腔局限性肌壁浸润性膀胱癌同步化放疗可取得优于单纯放疔疗效．膀胱癌放疗后大部分患者可以保存正常膀胱功能，不良反应可接受。Objective To analyze the efficacy and its impacting factors of pelvic confined muscle invasive bladder cancer （ MIBC ） treated with radiotherapy, also including the preservation of functional bladders and the treatment related late toxicity. Methods Forty-five MIBC patients who received radiotherapy from March 1999 to October 2016 in our hospital were analyzed. 41 of the patients were transitional cell carcinomas. The radiation volume included the bladder ±pelvic lymph node with or without local tumor boost,with a median bladder dose of 45 Gy and median tumor dose of 56 Gy.24 patients received concurrent chemoradiotherapy. 14 patients received neoadjuvant chemotherapy, and 29 underwent transurethral resection of bladder tumors before radiotherapy. Results The median follow-up duration was 28 months （range,4 101 months）.The 3-year overall survival were 51%. Concurrent chemoradiotherapy had a better survival than that of radiation alone,with 3-year overall survival of 64% and 30% （P= 0. 001 ）.The effect of neoadjuvant chemotherapy on 3-year overall survival was not obvious,59% and 47% （P= 0. 540） with or without neoadjuvant chemotherapy. The 3-year overall survival were 58% and 43% （P= 0. 160） ,respectively for patients with or without the transurethral resection of bladder tumors. The 3-year overall survival were 20% and 79% （P= 0. 001 ） for patients with or without relapse. Nine patients recurred locally and fourteen patients developed metastases. The highest bowel toxicity of more than 3 months after radiotherapy was grade 2 in 2 patients. Late grade 2 urinary toxicity occurred in 4 patients, grade 3 in 2 patients. All other patients preserved their functional bladders except 7 patients who had an uncontrolled bladder tumors or radiation induced severe injury of bladder function. Conclusions A better survival could be obtained for localized muscle invasive bladder cancer treated with concurrent chemoradiotherapy. Most of the patients can preserve their functional bladders after radiother

关 键 词：膀胱肿瘤/同步化放疗法 治疗结果 

分 类 号：R737.14[医药卫生—肿瘤]