吡柔比星与卡介苗交替灌注预防浅表性膀胱癌术后复发的疗效观察

目的观察吡柔比星(THP)与卡介苗(BCG)交替灌注的化学免疫疗法预防浅表性膀胱癌术后复发的疗效。方法将128例行经尿道膀胱癌电切术的浅表性膀胱癌患者,随机分为3组:Ⅰ组行THP与BCG交替灌注(48例)、Ⅱ组行THP灌注(40例)、Ⅲ组行BCG灌注(40例),随访5年,比较三组肿瘤复发率。结果随访18月~5年,平均4.2年,三组患者复发率分别为8.3%(4/48)、17.5%(7/40)和20%(8/40),Ⅱ、Ⅲ组比较差异无统计学意义(P>0.05),Ⅰ组复发率低于Ⅱ、Ⅲ组(P<0.05)。结论吡柔比星与卡介苗交替灌注的化学免疫疗法明显降低了浅表性膀胱癌的术后复发率,优于单用化疗药物或免疫制剂。     

卡介苗灌注预防膀胱肿瘤术后复发的疗效观察--附9例报告

目的：评价卡介苗灌注预防膀胱肿瘤术后复发的疗效,探讨其药理机理。方法：回顾性总结1996年8月－1999年12月共9例开放式膀胱肿瘤切除术后卡介苗灌注的随访资料,结果：本组随访8月－4年,平均31．6月,卡介苗灌注后均做膀胱镜检及病理活检,无1例肿瘤复发,结论：卡介苗灌注对膀胱肿瘤切除术后预防后预防复发近中期疗效是肯定的,个别临床并发症经对症处理可完全治毹。     

吡柔比星预防浅表性膀胱癌术后复发22例

膀胱灌注局部化疗是预防膀胱癌术后复发的重要手段。 1998～ 2 0 0 0年 ,我院对膀胱癌术后病人早期膀胱灌注吡柔比星 (THP)预防浅表性膀胱癌复发2 2例 ,疗效满意。1　临床资料1 1　一般情况　 2 2例中 ,男 19例 ,女 3例 ;年龄39～ 71岁 ,平均 5 2 6岁。初发 17例 ,复发 5例。单发 15例 ,多发 7例。病理诊断均为移行细胞癌 ,肿瘤分期 :Tis 2例 ,Ta 8例 ,T112例。肿瘤分级 :G115例 ,G2 5例 ,G3 2例。手术方法 :TUR Bt 2 0例 ;膀胱部分切除 7例中 ,行输尿管膀胱再植术 2例。1 2　治疗方法　术后 1周开始行THP膀胱灌注 ,THP 4 0mg +…     

卡介苗膀胱灌注的并发症2例

卡介苗 (ＢＣＧ )膀胱内灌注用于预防和治疗浅表性膀胱肿瘤的复发具有较好的效果 ,但如果使用不当 ,也会出现一些并发症。现将我院收治的 2例报告如下。1　病例报告例 1　男性 ,35岁。 1987年 9月因膀胱肿瘤在外院行膀胱部分切除术。术后 2周开始用卡介苗经尿道向膀胱内灌注。每周 1次 ,剂量为 15 0ｍｇ。灌注 8次后 ,病人出现排尿困难 ,且进行性加重。行尿道扩张治疗 ,并用抗结核药物治疗。 1988年 9月症状加重 ,行尿道狭窄内切开术。 1989年11月再次出现排尿困难 ,行尿道口切开术 ,效果不佳。 1991年Ｂ超检查提示双肾积水 ,来我院治疗行会…     

经尿道卡介苗膀胱灌注10年回顾

膀胱肿瘤经尿道电切 (ＴＵＵＲ ＢＴ)或膀胱部分切除后 ,40 %～ 70 %的患者将复发 ,其中约 2 0 %复发后的病理分级进一步升高 ,临床分期进一步加深[1] 。因此降低膀胱肿瘤术后复发是根治膀胱肿瘤的关键问题。我科自 1988年 10月～ 2 0 0 0年 2月对 132例浅表膀胱癌患者术后行膀胱内卡介苗 (ＢＣＧ)灌注治疗 ,预防复发 ,获得较满意效果 ,现报告如下。1　临床资料1 1　一般资料　本组 132例 ,男 90例 ,女 42例 ,年龄 2 8～ 84岁 ,平均 6 3 6岁。 10 4例初发 ,2 8例复发。膀胱部分切除 38例 ,经尿道肿瘤电切 94例。经病理证实均为膀胱移行细胞…     

丝裂霉素C和卡介苗序联灌注预防膀胱癌术后复发47例

膀胱腔内灌注局部化疗或免疫治疗是预防膀胱肿瘤术后复发的一个重要手段。我院自1994年6月～2002年12月应用丝裂霉素C(Milomycin C,MMC)和卡介苗(Bacillus Calmette-Guerin,BCG)顺序联合膀胱灌注预防浅表性膀胱癌局部切除术后复发47例,经随访观察,疗效满意,现报道如下。     

表柔比星联合卡介苗膀胱灌注预防膀胱癌术后复发的临床研究

目的比较表柔比星(EPI)联合卡介苗(BCG)与单用表柔比星膀胱灌注预防膀胱癌术后复发的疗效及安全性。方法确诊膀胱移行上皮癌,病理结果Ⅰ～Ⅱ期的患者36例,行经尿道膀胱肿瘤电切术后随机分成联合组、单用组,每组18例。联合组术后第1周灌注EPI,第2周灌注BCG,每周交替使用灌注药物,共8次后,用BCG每月1次灌注,共8次;单用组术后每周灌注EPI,共8次后,用EPI每月1次灌注,共8次。比较两组治疗后3年内的膀胱肿瘤复发情况、药物治疗期间泌尿系感染及不良反应的发生率。结果两组患者治疗后3年内的膀胱肿瘤复发率方面,联合组与单用组比较差异无统计学意义;药物治疗期间泌尿系感染与不良反应发生率方面,联合组较单用组比较发生率更低,差异具有统计学意义。结论 EPI联用NCG和EPI单用均具有良好的预防肿瘤复发效果,而EPI联用BCG可显著减少治疗期间的泌尿系感染和不良反应发生,患者依从性更好。     

鸦胆子油乳膀胱内灌注预防浅表性膀胱癌术后复发

目的评价鸦胆子油乳膀胱灌注预防浅表性膀胱癌术后复发的疗效和安全性。方法对365例浅表性膀胱癌患者行TURBT或膀胱部分切除术,术后1周给予10%鸦胆子油乳60 m l膀胱内灌注,药物于膀胱内保留2 h,每周1次,连续6周,以后每月1次,连续12个月。定期做血、尿常规、肝肾功能及膀胱镜检查,并记录每次膀胱灌注后的全身及局部反应。结果365例均未见全身性药物不良反应,随访9~36个月,平均23个月,复发35例,复发率9.6%。结论鸦胆子油乳膀胱灌注防止浅表性膀胱癌术后复发疗效满意,安全性好。     

THP和MMC膀胱内灌注治疗浅表性膀胱癌疗效观察

目的评价吡柔比星（THP）、丝裂霉素C（MMC）两种药物膀胱灌注治疗浅表性膀胱癌的不同疗效。方法将64例浅表性膀胱癌随机分为两组,分别用THP和MMC作膀胱灌注治疗药物,观察其不同疗效。结果所有病例随访3～24个月,平均14个月。THP组复发率11.76%（4/34）,MMC组复发率23.33%（7/30）,差别具有统计学意义（P〈0.05）。结论 THP膀胱灌注防治浅表性膀胱癌术后复发的疗效优于MMC,可作为临床一线用药。     

浅表性膀胱癌组织学形态及Ki-67、p53表达与肿瘤复发的关系

目的探讨浅表性膀胱癌组织学形态以及Ki-67、p53表达与肿瘤复发的关系。方法将54例浅表性膀胱癌分为复发组和无复发组。复习肿瘤组织学形态并根据1998年WHO／ISUP分类标准进行重新分类。免疫组化法检测Ki-67和p53的表达并比较复发组与无复发组的差异。结果在平均32个月的随访中，28例复发，占52％，其中5例为低度恶性潜能的乳头状移行细胞瘤，14例为低级别乳头状瘤，9例为高级别乳头状瘤。而26例无复发肿瘤中4例为乳头状瘤，12例为低度恶性潜能的乳头状移行细胞瘤，8例为低别乳头状瘤，2例为高级别乳头状瘤。低度恶性潜能肿瘤复发率为29．4％（5／17），低级别和高级别乳头状瘤术后复发率分别为63．6％（14／22）和81．8％（9／11），而乳头状瘤无一例复发。Ki-67和p53阳性率在两组之间有明显差别，复发组均明显高于无复发组（P〈0．05）。在乳头状瘤病例中，Ki-67和p53联合表达的病例复发率明显高于无联合表达者（P〈0．01）。结论浅表性膀胱癌术后复发与组织学有关，Ki-67、p53阳性表达尤其是联合阳性表达对判断膀胱癌复发具有重要意义。     

盐酸米托蒽醌膀胱灌注预防膀胱癌术后复发

目的：探讨米托蒽醌（MTZ）在预防膀胱癌术后复发中的作用。方法：对行保留膀胱手术治疗的18例膀胱癌患者，术后2周予以盐酸米托蒽醌12mg＋生理盐水50ml灌注，药物于膀胱内保留2h，1次／周，连续8周；然后1次/月，连续12个月。定期做血、尿常规和肝、肾功能及膀胱镜检查。结果：18例均获得随访，随访时间6～18个月，平均12个月，其中复发2例，复发率11．1％。结论：盐酸米托蒽醌膀胱灌注预防膀胱癌术后复发具有较好的临床效果及安全性，值得临床推广使用。     

Multisystemic BCGitis: A rare complication of intravesical BCG immunotherapy for bladder cancer

Intermediate- to high-grade non-muscle invasive bladder cancer is preferably treated with transurethral resection followed by adjuvant intravesical immunotherapy with Bacillus Calmette-Guérin (BCG). BCG acts as an immune stimulator, inducing a complex inflammatory response that selectively targets tumoral cells. Mild side effects of BCG instillation, such as fever, malaise, and bladder irritation are frequent, while severe treatment-associated complications of the genito-urinary tract are rare. “Distant” complications are even rarer and, since BCG is able to disseminate hematogenously, virtually all organs and systems can be involved, with the lungs, liver and musculoskeletal system being most commonly affected. Vascular complications of BCG immunotherapy are exceedingly rare and difficult to diagnose, because they can mimic other vascular infections and may occur several years after treatment. Knowledge of previous BCG immunotherapy and awareness about treatment-related complications is essential to avoid misdiagnosis, and to guide appropriate treatment.     

曼月乐和妈富隆预防子宫内膜息肉复发的效果比较

目的 探讨宫内放置左炔诺孕酮宫内缓释系统(曼月乐环)或口服去氧孕烯炔雌醇片(妈富隆),在子宫内膜息肉电切除术(TCRP)后预防子宫内膜息肉复发的效果.方法 子宫内膜息肉行TCRP术患者共137例,其中63例术后选择宫内放置曼月乐环,74例选择口服妈富隆3～6个月,观察比较两组子宫内膜息肉复发、子宫内膜厚度变化情况.结果 术后6个月和12个月复查,曼月乐组无复发病例,妈富隆组有14例复发,复发率为18.9％,两组复发率有统计学差异(P＜0.05).术后6个月复查,两组子宫内膜厚度比较差异无统计学意义(P＞0.05);术后12个月复查,曼月乐组子宫内膜厚度较妈富隆组明显变薄(P＜0.05).结论 TCRP术后宫内放置曼月乐较口服妈富隆更能有效预防子宫内膜息肉的复发.     

Transrectal radiofrequency ablation for pelvic recurrence of bladder cancer: case report and review of complications

Pelvic recurrences after radical surgery for intestinal and urologic cancers can cause substantial pain and morbidity as a result of nerve and visceral organ invasion. Treatment options are frequently limited by previous radiation and inefficacy of systemic chemotherapy. There are a few reports of percutaneous radiofrequency (RF) ablation for local control or palliation of symptoms, but this approach has been associated with considerable morbidity. In the present case, transrectal RF ablation of recurrent bladder cancer was performed for palliation of intractable pain. The associated complications and the pertinent literature will be reviewed.     

Comparison of adaptive radiotherapy techniques for the treatment of bladder cancer

Objective

Day-to-day anatomical variations complicate bladder cancer radiotherapy treatment. This work quantifies the impact on target coverage and irradiated normal tissue volume for different adaptive strategies.

Methods

20 patients were retrospectively planned using different three-dimensional conformal radiotherapy treatment strategies for whole-bladder carcinoma: (i) “conventional” treatment used isotropic expansion of the clinical target volume (CTV) by 15 mm to the planning target volume (PTV) for daily treatment; (ii) “plan of the day” used daily volumetric on-treatment imaging [cone beam CT (CBCT)] to select from four available plans with varying superior PTV margins; (iii) “composite” strategies used on-treatment CBCTs from Fractions 1–3 to inform a composite CTV and adapted PTV (5- and 10-mm margins for composite 1 and composite 2, respectively) for subsequent treatment. Target coverage was evaluated from available CBCTs (the first three fractions then the minimum weekly thereafter), and the reduction in the irradiated volume (i.e. within the 95% isodose) was quantified.

Results

Plan of the day improved target coverage (i.e. all of the bladder within the 95% isodose throughout the treatment) relative to conventional treatment (p=0.10), while no such benefit was observed with composite 2. Target coverage was reduced with composite 1 relative to conventional treatment. The mean irradiated volume was reduced by 17.2%, 35.0% and 14.6% relative to conventional treatment, for plan of the day, composite 1 and composite 2, respectively (p<0.01 in all cases). No parameters predictive of large changes in bladder volume later in the treatment were identified.

Conclusions

Adaptive techniques can maintain or improve target coverage while allowing for reduced irradiated volume and possibly reduced toxicity. The plan-of-the-day technique appeared to provide the optimal balance between target coverage and normal tissue sparing.

Advances in knowledge

This study suggests that plan-of-the-day techniques will provide optimal outcomes for adaptive bladder radiotherapy.Muscle-invasive bladder cancer affects over 3000 new patients every year in the UK [1]. Although patients can undergo radical cystectomy, bladder preservation offers comparable outcomes with the added advantage of the patient retaining their own bladder [2]. This means that there is increasing interest in bladder preservation. Patients are treated with maximal transurethral resection of the bladder, neoadjuvant chemotherapy and radiotherapy [3]. Use of concurrent radiosensitisers further improves outcomes [4,5]. With combined modality treatment, local control rates of 70–80% can be achieved. Although this is promising, there is scope for improvement. Higher radiotherapy doses may offer increased local control, but are limited by normal tissue toxicity, with some patients experiencing significant urinary and bowel toxicity [6].Radiotherapy for bladder cancer in the UK involves irradiation of the entire bladder, with a generous margin to account for variations in bladder position, shape and size. However, this is likely to be a suboptimal approach, leading to unnecessarily high doses to normal tissue where bladder volume remains small, while failing to achieve target coverage for patients who encounter increasing bladder volume throughout treatment [7]. Henry et al [8] found that 26% of bladder patients monitored using cone beam CT (CBCT) required replanning owing to increasing bladder volume (53%), decreasing bladder volume (38%) and decreasing rectal volume (9%). The authors recommended development of adaptive radiotherapy protocols for these patients. Strategies aimed at reducing these variations by coaching patients to achieve consistent bladder volumes through drinking protocols have generally met with limited success, despite good patient compliance [9].Daily variations throughout treatment make bladder radiotherapy technically challenging and, with the incidence of bowel toxicity, mean that adaptive strategies could be beneficial. Burridge et al [10] retrospectively investigated the potential of a “plan-of-the-day” approach to this problem, which involved generating three plans based on the bladder volume seen on the radiotherapy planning (RTP) scan with variable superior expansion margins (5, 10 and 15 mm) but uniformity in other directions (15 mm). Based on CBCT images acquired throughout treatment (days 1–5 and weekly thereafter), the optimal plan was selected for treatment. The study demonstrated an average small bowel sparing of 31 cm³ (maximum 76 cm³) compared with non-adaptive techniques.Adaptive techniques are complicated by intrafractional bladder filling: Lotz et al [11] demonstrated that bladder filling rates varied significantly in healthy volunteers, although flow rates for individuals were consistent. To investigate an adaptive plan-of-the-day strategy, Murthy et al [12] acquired megavoltage CT images before and after each treatment fraction, finding that >16% of patients no longer had their bladder contained within the required region at the end of treatment. Studies often account for this effect with an additional 2- to 3-mm margin for intrafractional expansion, although customised approaches have been investigated [13].Alternative adaptive strategies can be broadly classed as “composite” plan approaches. These involve acquisition of several images of patient anatomy on successive days, from which a composite clinical target volume (CTV) [and planning target volume (PTV)] is determined as the union of CTVs observed on each scan. Pos et al [14] used this approach to define a composite CTV based on the observed position on CT scans for the first five fractions, subsequently expanding 10 mm isotropically to a composite PTV. This allowed a 40% reduction in overall irradiated volume with minimal compromise to target coverage.The current work aims to expand on previous studies by making a direct quantitative comparison between different adaptive approaches for whole-bladder radiotherapy within the same patient cohort. Unlike earlier studies, a patient-specific comparison of the appropriateness of each technique will be provided to investigate whether the optimal adaptive strategy varies for particular patients, and whether the optimal strategy could be determined and adopted early in treatment. It was impractical to investigate all of the above approaches owing to subtle variations between investigators and so the focus is on specific examples of each broad approach.     

三种腔镜技术应用于治疗非浸润性膀胱肿瘤的疗效、安全性比较

 目的 探讨绿激光、等离子双极电气化、普通电切3种腔镜技术治疗非浸润性膀胱肿瘤的有效性、安全性。方法 对536例次非浸润性膀胱肿瘤患者进行回顾性研究分析, 绿激光组215例, 等离子组187例, 普通电切组134例, 对3组之间的手术时间、术后留置尿管时间、术后住院时间、术后复发率、并发症等进行比较。结果 3组之间的手术时间［(50.18±18.76) min vs (49.88±13.23) min vs (51.21±15.32) min］之间的差异无统计学意义。术后留置尿管时间绿激光组与其他两组相比差异具有统计学意义［(4.92±3.67) d vs (9.16±4.56) d vs (9.37±5.78) d, P＜0.05］, 后两组间差别无统计学意义。术后住院时间三组之间差异均具有统计学意义［(7.64±4.87) d vs (13.15±12.84) d vs (16.24±13.23) d, P＜0.05］, 绿激光组时间最短, 电切组时间最长。绿激光组术后复发率明显低于其他两组, 且其差异具有统计学意义(7.4% vs 15.5% vs 17.2%, P＜0.05), 后两组差异无统计学意义。膀胱痉挛(4.2% vs 9.6% vs 15.7%)、继发性出血(0% vs 7.5% vs 13.4%)等并发症的发生在绿激光组最低, 其差异具有统计学意义(P＜0.05), 而等离子组和电切组之间的差异无统计学意义(P＜0.05)。结论 绿激光治疗非浸润性膀胱肿瘤是安全、有效的, 具有创伤小、出血少、留置尿管时间短、术后住院时间短、恢复快、术后复发率低等优势, 其在手术局部不产生电场效应, 从而避免了闭孔神经反射的发生。     

磁共振扩散加权成像不同b值及表观扩散系数值与膀胱癌T分期、浸润、复发情况关系研究

目的探讨磁共振扩散加权成像(DWI)不同b值及表观扩散系数(ADC)值与膀胱癌T分期、浸润、复发情况的关系。方法选取自2013年1月至2018年1月宜宾市第一人民医院收治的100例膀胱癌患者为研究对象。对所有患者进行病灶部位磁共振动态增强扫描(DCE-MRI)检查,分析不同病理类型患者的DCE-MRI时间-信号强度曲线,以及DCE-MRI、DWI单独检测和联合检测对患者复发情况预测价值间的差异。结果不同临床病理分期及疾病类型膀胱癌患者的DCE-MRI时间-信号强度曲线比例比较,差异有统计学意义(P<0.05)。随患者病情严重程度的增加,ADC值明显降低,且b值为800 s/mm~2的ADC值显著高于b值为1 000 s/mm~2的ADC值,组间比较,差异有统计学意义(P<0.05)。DCE-MRI、DWI联合检测对膀胱癌患者的诊断曲线下面积高于DCE-MRI、DWI单独检测,组间比较,差异有统计学意义(P<0.05)。对膀胱癌复发患者的Logistics回归分析结果发现,不同T分期、浸润情况及ADC值均为膀胱癌患者复发的独立影响因素。结论 ADC值及b值的选择,对确定膀胱癌患者的T分期、浸润情况及复发情况具有积极的作用。DCE-MRI、DWI联合检查对膀胱癌患者的复发具有一定的预测价值。