新辅助放疗联合cTURBT和辅助化疗治疗直径≥3cm的T_(2)期MIBC的疗效与安全性  

Efficacy and safety of neoadjuvant radiotherapy combined with cTURBT and adjuvant chemotherapy for the treatment of T_(2) stage MIBC≥3 cm in diameter

作　　者：张志华[1] 陈雅童 罗飞[1] 王亚申 李健[1] ZHANG Zhihua;CHEN Yatong;LUO Fei;WANG Yasshen;LI Jian(Department of Urology,Tianjin Union Medical Center,Tianjin 300121,China)

机构地区：[1]天津市人民医院泌尿外科,天津300121

出　　处：《现代泌尿生殖肿瘤杂志》2024年第4期223-228,共6页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨新辅助调强适形放疗联合“最大化”经尿道膀胱肿瘤电切术(cTURBT)和辅助化疗治疗肿瘤直径≥3 cm的T 2期肌层浸润性膀胱癌(MIBC)的疗效与安全性。方法回顾性分析天津市人民医院泌尿外科收治的接受新辅助放疗联合cTURBT和辅助化疗的31例病灶直径≥3 cm的T 2期MIBC患者的临床资料,随访患者复发、转移、生存、死亡情况。结果31例患者均接受新辅助放疗,放疗总剂量为48(44,50)Gy,放疗后3例(9.7%)完全缓解,19例(61.3%)部分缓解,客观缓解率为71.0%,疾病控制率为96.8%。所有患者顺利行cTURBT术,手术时间37(31,42)min,出血量为20(10,30)ml,无围手术期输血患者,术后住院时间为4(4,5)d,术中无闭孔神经损伤、膀胱穿孔、严重出血、经尿道电切综合征发生。随访患者12~36个月,9例(29.0%)患者复发,中位复发时间18(10,23.5)个月,6例患者为膀胱内复发,其中5例再次行cTURBT术联合膀胱灌注治疗,1例行挽救性根治性膀胱切除术(RC);2例出现膀胱内复发和淋巴结转移,其中1例行cTURBT联合免疫治疗,1例行挽救性RC;1例出现全身多发转移,行姑息性治疗。结论新辅助放疗联合cTURBT和辅助化疗治疗直径≥3 cm的T 2期MIBC患者,保膀胱成功率高,可作为不能或不愿接受RC患者的保膀胱治疗策略。Objective To investigate the efficacy and safety of neoadjuvant intensity modulated radiation therapy combined with"complete"transurethral resection of bladder tumor(cTURBT)and adjuvant chemotherapy for the treatment of T_(2) stage muscle invasive bladder cancer(MIBC)≥3 cm in diameter.Methods A retrospective analysis was performed on the clinical data of 31 patients with T_(2) stage MIBC≥3 cm in diameter who received neoadjuvant radiotherapy combined with cTURBT and adjuvant chemotherapy in Tianjin Union Medical Center from January 2018 to December 2022.During the follow-up period,the patients'recurrence,metastasis,survival,and death were recorded.Results All 31 patients received neoadjuvant radiotherapy with a total dose of 48(44,50)Gy,Three patients(9.7%)achieved complete response,and 19 patients(61.3%)achieved partial response.The objective response ratewas 71.0%,and the disease control rate was 96.8%.All patients underwent cTURBT with surgery time of 37(31,42)minutes and blood loss was 20(10,30)ml.The postoperative hospitalization time was 4(4,5)days.There were no cases of obturator nerve injury,bladder perforation,ureteral opening injury,severe bleeding,or TUR syndrome during the operation.Patients were followed up for 12 to 36 months,and 9 patients(29.0%)relapsed with a median recurrence time of 18(10,23.5)months.Six patients had intravesical recurrence.Five of them underwent cTURBT in combination with bladder instillation therapy,and 1 case underwent salvage radical cystectomy(RC).Two patients had both intravesical recurrence and lymph node metastasis.One of them received cTURBT combined with immunotherapy,and the other case received salvage RC.Only one patient had multiple systemic metastases,then received palliative treatment.Conclusions The combination of neoadjuvant radiotherapy,cTURBT and adjuvant chemotherapy for the treatment of patients with T_(2) stage MIBC≥3 cm in diameter,has a high success rate in bladder preservation,and could be used as a new bladder-preserving treatment for patients wh

关 键 词：肌层浸润性膀胱癌 新辅助调强适形放疗 “最大化”经尿道膀胱肿瘤电切术 肿瘤复发 

分 类 号：R737.14[医药卫生—肿瘤]