髂内动脉灌注化疗联合放疗治疗浸润性膀胱癌

目的：评估髂内动脉灌注化疗联合放疗治疗浸润性膀胱癌的有效性及安全性。方法：对18例无法耐受或不愿接受膀胱全切手术的浸润性膀胱癌患者进行保留膀胱治疗,包括髂内动脉灌注化疗联合盆腔放疗。化疗药物包括顺铂、表阿霉素、丝裂霉素。平均放疗剂量为30～40Gy。结果：经3次化疗、栓塞及一个疗程的盆腔放疗,完全缓解率44．4％(8／18),部分缓解率55．6％(10／18);对部分缓解患者进行经尿道膀胱肿瘤切除术(TURBT)或膀胱部分切除术。所有病例定期随访,中位随访期为24．3个月。对随访期间发现的肿瘤复发进行再次TURBt或膀胱部分切除术。2例死于肿瘤。结论：髂内动脉灌注化疗联合放疗作为浸润性膀胱癌患者保留膀胱手术前新的辅助治疗,在提高生存率的同时可改善生活质量。

Bladder preservation by internal iliac arterial infusion chemotherapy and radiotherapy in invasive bladder carcinoma

Objective:To evaluate the efficacy of bladder sparing treatment by internal iliac arterial infusion chemotherapy and radiotherapy in invasive bladder carcinoma.Method:All the 18 patients with invasive bladder cancer underwent bladder sparing treatment,who rejected or could not bear the total cystectomy. The treatment protocol consisted of intra arterial chemotherapy via catheters inserted in the internal iliac arteries and radiotherapy. Total dose of radiotherapy was 30 to 40 Gy.Result:At the end of neo-adjuvant therapy, 8 patients ( 44.4 %) showed a complete response (CR) and 10 patients ( 55.6 %) showed a partial response (PR). Extensive transurethral resection and partial cystectomy were performed for 10 PR cases with residual tumor. All patients were followed observationally. The median duration of follow up was 24.3 months. Recurrent superficial tumors were treated transurethrally. Overall, 2 patients died of cancer.Conclusion:This pilot study demonstrates that the bladder sparing approach for the treatment of invasive bladder carcinoma which utilizes combined intra arterial chemotherapy and radiotherapy may avoid the decline in quality of life induced by urinary diversion and yield equivalent therapeutic benefit to that of radical cystectomy. Bladder salvage is feasible in select patients.