109例膀胱癌三维适形放疗临床分析

目的 回顾分析109例膀胱癌三维适形放疗疗效、副作用及预后因素.方法 近12年内接受三维适形放疗的原发膀胱癌患者109例,年龄41～94岁(中位值68岁).4例未行手术治疗,105例行保留膀胱手术.根据2003年UICC分期标准分期,T1、T2a、T2b、T3a、T3b、T4期分别为29、27、33、15、2、3例.N0期92例,N1期7例,N分期不详10例.所有患者均接受了常规分割三维适形放疗,总剂量39.3～62.2Gy(中位值49.6 Gy),其中57例采用全膀胱加局部瘤区野中野照射,局部瘤区单次剂量为1.9～2.2Gy(中位值2.0 Gy).结果 随访2～144个月(中位值36个月),总随访率为98%,其中1、3、5年随访率分别为95%、53%、32%.1、3、5年局部控制率分别为63%、47%、42%,总生存率分别为80%、48%、37%.多因素分析结果表明总生存率的独立预后因素为T分期、病理类型、N分期和不同放疗方式.膀胱局部控制率的独立预后因素为KPS评分、不同手术方式以及放疗与手术间隔时间.全组中肿瘤相关死亡33例.放疗后膀胱内复发42例,盆腔或腹腔淋巴结转移22例.根据RTOG分级标准,急性泌尿系统反应1级22%,2级59%,3级12%,4级1%;晚期泌尿系统反应1级29%,2级28%,3级2%,4级1%.结论 三维适形放疗在膀胱癌治疗中特别是全膀胱加局部瘤区野中野照射方式可取得较好临床效果,副作用在可接受范围,可作为保留膀胱功能手术患者的一种治疗方法.

Outcome of three-dimensional conformal radiotherapy for 109 patients with bladder cancer

Objective To study the efficacy,late complications and prognostic factors of postopera-tive radiotherapy for bladder cancer: Methods Between July 1995 and January 21307,109 patients with primary bladder cancer who had received adjuvant pelvic radiation therapy were retrospectively analyzed. The age ranged from 41 to 94 (median 68) years. There were 29 patients with T1 disease,60 with T2,17 with T3, 3 with T4, and 7 with positive lymph node. Three-dimensional radiotherapy was given with a median total dose of 49.2 Gy(39.3 -62.2 Gy) in conventional fractionation after surgery. Field-in-field intensity modu-lated radiotherapy was given to 57 patients. Results The total follow-up rate was 98% ,with a median fol-low up time of 36(2-144) months. The 1-,3- and 5-year local control rate was 63% ,47% and 42% ,respec-tively. The 1-,3- and 5-year overall survival rate was 80% ,48% and 37% ,respectively. Among the 109 pa-tients,33 died of tumor progression or metastasis,42 showed local recurrence,and 22 had lymph node metas-tasis. According to the RTOG criteria,grade 1,2,3 and 4 radiation related early urological side effects were 22% ,59% ,12% and 1% ,respectively;The corresponding late urological side effects were 29% ,28% ,2% and 1%, respectively. Two patients underwent whole bladder cystectomy due to the radiation related side effects. Conclusions Postoperative three-dimensional radiotherapy, achieving high response rate with tol-erable side effects, can be offered as an alternative option to the radical cystectomy in the bladder conserving treatment.