Ir192腔内近距离放疗结合顺铂膀胱灌注预防膀胱癌术后复发的疗效观察

目的　探讨Ir192 腔内近距离放疗结合顺铂膀胱灌注预防膀胱癌术后复发的疗效。方法　综合组Ir192 腔内近距离放疗结合顺铂膀胱灌注与对照组单纯PDD膀胱灌注预防膀胱癌术后复发进行随机对照观察。结果　综合组2 5例 ,对照组 2 0例 ,均随访 12～ 3 6个月。综合组 1年无癌生存率 85 % ,复发率 15 %。 3年无癌生存率 64 % ,复发率3 6%。对照组 1年无癌生存率 75 % ,复发率 2 5 %。 3年无癌生存率 5 0 % ,复发率 5 0 %。结论　Ir192 腔内近距离放疗结合顺铂膀胱灌注预防膀胱癌术后复发的疗效优于单纯顺铂膀胱灌注     

二次TUR联合即刻灌注治疗非肌层浸润性膀胱癌的临床研究

目的:观察二次TUR联合即刻膀胱灌注化疗药物治疗非肌层浸润性膀胱癌的安全性及疗效。方法:T1期非肌层浸润性膀胱癌患者120例分为2组:实验组58人,患者在第一次TUR术后24h内膀胱灌注化疗药物,4-6周行二次TURBt,以后按常规膀胱灌注化疗;对照组62人,TUR术后1周常规膀胱灌注化疗。观察两组肿瘤复发情况以及不良反应。结果:本组总复发率21.7%(26/120)。实验组1年内复发1例(1.7%),1-2年内复发4例(6.9%);对照组1年内复发8例(12.9%),1-2年内复发13例(21.0%),两组复发率比较差异有统计学意义(P<0.05)。实验组不良反应8例,对照组不良反应7例,比较差异无统计学意义(P>0.05)。结论:即刻膀胱灌注化疗及二次TUR可降低非肌层浸润性膀胱癌的复发率,不良反应并无增加。     

新辅助介入化疗及放疗后经尿道切除治疗浸润性膀胱癌

目的：评价新辅助动脉介入化疗、盆腔放疗结合经尿道切除治疗浸润性膀胱癌的效果：方法：对13例平均年龄68．3岁、有膀胱全切指征而患者无法耐受或不愿接受膀胱全切手术的浸润性膀胱移行细胞癌(T2-3/G1-3)进行保留膀胱的治疗：治疗方式采用新辅助动脉介入化疗、盆腔放疗及经尿道切除：经髂内动脉灌注的化疗药物为顺铂80mg、表柔比星50mg、氟尿嘧啶1g或喜树碱30mg，放疗平均剂量为30～50Gy.结果：经新辅助动脉介入化疗及盆腔放疗，膀胱癌瘤体明显缩小，完全缓解(CR)1例(7．69％)，部分缓解(PR)12例(92．31％)，缩小的癌灶经尿道电切或钬激光得以顺利切除，患者膀胱得以保留：所有病例定期随访，平均随访26．46个月。肿瘤复发5例(38．46％)，对复发肿瘤行再次经尿道切除或化、放疗。结论：虽然根治性膀胱全切术是浸润性膀胱癌的主要治疗方法，但在部分病例中可选择新辅助介入化疗、放疗结合经尿道切除的治疗，初步的结果提示疗效良好，且患者保留膀胱功能、获得了较好的生活质量。     

保留膀胱手术联合动脉化疗治疗浸润性膀胱癌的临床研究

目的 评价保留膀胱手术联合动脉化疗治疗浸润性膀胱癌的临床疗效.方法 2003年4月～2006年12月,对35例浸润性膀胱癌患者采用经尿道膀胱肿瘤电切或膀胱部分切除术联合GC(吉西他滨 顺铂)方案动脉化疗治疗,总结分析肿瘤控制情况、膀胱保存率和患者的生存率.结果 33例患者获随访,2例失访,平均随访24.3个月(3～45个月).27例无瘤生存,2例带瘤生存,4例死于肿瘤转移,2年生存率为88.8%;19例无复发及转移,5例浅表性复发,3例浸润性复发,6例转移;25例保留膀胱生存,4例行挽救性全膀胱切除,4例死亡,2年膀胱保存率为74.1%.全部患者对动脉化疗耐受良好,无严重全身和局部不良反应.结论 保留膀胱手术联合GC方案动脉化疗治疗浸润性膀胱移行细胞癌近期疗效满意,毒副作用轻,值得临床进一步观察研究.     

Ir^192腔内近距离放疗结合顺铂膀胱灌注预防膀胱癌术后复？…

目的 探讨Ｉｒ＾１９２腔内近距离放疗结合顺铂光灌注预防胱癌术后复发的疗效。方法 综合组Ｉｒ＾１９２腔内近期距离放疗结合顺铂膀胱灌注与对照组单纯ＰＤＤ膀胱灌注预防膀胱癌术后复发进行随机对照研究。结果 综合组２５例,对照组２０例,均随访１２￣３６个月。     

膀胱粘膜下浸润注射盐酸氮芥预防膀胱癌术后复发(附106例报告)

目的:评价膀胱粘膜下浸润注射盐酸氮芥预防膀胱癌术后复发的疗效.方法:对106例(90例非浸润性、16例浸润性)膀胱癌患者行膀胱部分切除术,对其中5例浸润性膀胱癌同时切除邻近肿瘤的膀胱周围组织和区域淋巴结,术中用2mg%盐酸氮芥生理盐水溶液100ml～160ml在所剩余膀胱粘膜下全部浸润注射,术后定期用丝裂霉素C(MMC)膀胱灌注.结果:106例随访6个月～13年,平均9年.无肿瘤复发103例,复发3例,总复发率为2.9%.90例非浸润性癌全部无复发.16例浸润性癌,复发3例,复发率18.75%.结论:膀胱粘膜下浸润注射盐酸氮芥预防膀胱癌术后复发疗效好,降低复发率显著,毒副反应少,临床应用安全可靠.     

吉西他滨膀胱灌注预防高危非肌层浸润性膀胱癌术后复发的疗效观察

目的观察吉西他滨膀胱灌注预防高危非肌层性浸润膀胱癌术后复发的疗效。方法90例高危非肌层浸润性膀胱癌经尿道膀胱肿瘤电切(TURBt)术后患者随机分为两组,每组45例,分别采用吉西他滨(治疗组)和吡柔比星(对照组)膀胱灌注。术后定期行膀胱镜检查,观察两组患者肿瘤复发情况及不良反应。结果治疗组患者随访期间有7例复发,总复发率为15.5%;对照组患者随访期间有16例复发,总复发率为35.5%,两组差异有统计学意义(P<0.05)。治疗组发生不良反应10例,对照组发生不良反应9例,主要为尿频、尿急、尿痛和血尿等,对症治疗后缓解,两组患者均未发生严重不良反应。结论 TURBt术后膀胱灌注吉西他滨预防高危非肌层浸润性膀胱癌术后复发的疗效确切,患者耐受性好,是较理想的膀胱灌注化疗药。     

吉西他滨联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的效果观察

目的 探讨吉西他滨联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的效果.方法将80例初发非肌层浸润性膀胱癌患者分为试验组(40例)和对照组(40例).2组患者均行经尿道膀胱肿瘤切除手术(TURBT).对照组于术后行羟喜树碱膀胱灌注,试验组采用吉西他滨联合羟喜树碱膀胱灌注.定期对患者进行随访,时间为5年,观察对比2组患者术后6个月、术后1年、术后2年、术后3年和术后5年的复发率和进展率,以及不良反应发生情况.结果治疗后,试验组和对照组在术后6个月、术后1年和术后2年的复发率方面不具有统计学差异(P均>0.05),但是在术后3年和术后5年的复发率方面差异具有统计学意义(P<0.05);术后5年2组的进展率具有统计学意义(P<0.05).试验组不良反应发生率与对照组相比,差异具有统计学意义(P<0.05).结论采用吉西他滨联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发和单纯采用羟喜树碱防治的近期效果相近,但是远期效果显著,值得推广.     

动脉灌注化疗加放疗治疗浸润性膀胱癌

目的：探讨浸润性膀胱癌的有效治疗方法。方法：对髂内动脉灌注化疗加放疗治疗24例浸润性膀胱癌患者临床资料进行回顾性分析。结果：CR2例，PR20例，总有效率为91．6％(22／24)。22例具有全膀胱切除指征的患者均保留了膀胱正常排尿功能，患者生活质量提高，生命期明显延长。结论：动脉灌注化疗加放疗为晚期浸润性膀胱癌，尤其是不能或不愿行全膀胱切除术患者提供了一种有效的治疗方法。     

膀胱癌保留膀胱术后膀胱灌注药物的疗效观察

目的探讨吡柔比星（pirarubicin,THP）、羟基喜树碱（hydroxycamptothecin,HCPT）、丝裂霉素（mitomycin,MMC）三种不同药物膀胱灌注化疗对预防膀胱癌保留膀胱术后复发的安全性评估。方法将162例晋东地区膀胱癌保留膀胱术后膀胱灌注的膀胱癌患者随机分为三组,Ⅰ组采用THP方案（76例）,Ⅱ组采用HCTP方案（62例）,Ⅲ组采用MMC方案（24例）。分别于术后1～2周开始规律膀胱灌注。比较三组复发率。结果所有患者均随访2年以上。Ⅰ组复发率为13.5%,Ⅱ组复发率14.8%,Ⅲ组复发率19.6%。Ⅰ、Ⅱ组与Ⅲ组比较差异有显著性（P〈0.05）。结论THP、HCTP膀胱灌注对膀胱癌保留膀胱术后防止复发疗效满意,副作用轻,耐受性好且安全。     

膀胱癌保存膀胱术后综合治疗预防复发的疗效

目的 探讨放射治疗＋化疗预防肌层侵犯的浸润性膀胱癌保存膀胱术后复发的疗效。方法 23例肌层侵犯的浸润性膀胱移行细胞癌保存膀胱术后在丝裂霉素规则膀胱灌注化疗的基础上行放射治疗（研究组）,照射平均剂量为52．5Gy。以29例同期同样病变行保存膀胱术后单纯丝裂霉素规则膀胱灌注化疗的为对照（对照组）。结果 研究组除2例因放射在膀胱炎分别中断3d和后继续治疗外,其余均按计划完成治疗。所有病例随访3年以上,平均随访41．6个月。研究组和对照组3年盆腔复发率为18．8％和44．8％（P＝0．026）;3年远地转移率分别为18．2％和24．1％（P＝0．437）;3年生存率分别为81．8％和86．2％（P＝0．670）。结论 保存膀胱术后放射＋化疗治疗能有效降低肌层侵犯浸润性膀胱癌盆腔复发率,是膀胱癌保存膀胱术后理想的辅助治疗。     

力尔凡膀胱灌注预防浅表性膀胱尿路上皮癌术后复发的临床观察

目的探讨力尔凡膀胱灌注预防浅表性膀胱尿路上皮癌术后复发的临床效果。方法对152例浅表性膀胱尿路上皮癌术后患者,随机分成2组。试验组：力尔凡＋顺铂＋放疗;对照组：单纯顺铂＋放疗。对其复发率、复发间隔时间进行组问比较,对T细胞亚群和白细胞总数进行治疗前后的对比观察。结果试验组与对照组的复发率与复发间隔时间比较差异均有统计学意义（P均〈0．05）。试验组治疗前后NK细胞、CD4／CD8计数比较差异均有统计学意义（P均〈0．05）,治疗后明显高于治疗前;对照组治疗前后白细胞总数比较差异有统计学意义（P〈0．05）,治疗后明显低于治疗前。结论力尔凡不但可以杀灭肿瘤细胞,而且有免疫复苏作用,在体内与其他免疫因子和化疗药物起协同作用,在膀胱尿路上皮癌的综合治疗中,不失为一种化疗配伍的安全、有效的药物选择。     

吡柔比星与吉西他滨膀胱灌注化疗治疗膀胱癌的疗效比较

目的:评价吡柔比星与吉西他滨膀胱内灌注预防膀胱癌术后复发的疗效。方法:将42例保留膀胱手术治疗的膀胱癌患者分为A、B组,A组24例,B组18 例。分别使用吡柔比星与吉西他滨进行预防灌注,全部患者均术后即刻膀胱内灌注化疗,每周1次,共6次;以后每月1次直至1~2年,并做随访和疗效比较。结果:A、B两组生存率均为100%;A组复发率为25%（6/24）,B组复发率为27.8%（5/18),两组患者2年生存率、复发率比较差异无显著性意义（P>0.05）。A组和B组用药后膀胱刺激症状发生率、尿道狭窄发生率、全身不良反应发生率比较差异无显著性意义（P>0.05)。结论:吡柔比星与吉西他滨均可降低膀胱癌术后复发的机率,两者疗效无明显差异。膀胱内灌注预防浅表性膀胱癌术后复发近期疗效满意,副作用较轻,耐受性良好。     

Intraarterial cisplatin and concurrent radiation for locally advanced bladder cancer

Between 1983 and 1987 25 patients with invasive bladder cancer (16 stage tumor 3 (T3) and nine stage T4) were treated with intraarterial cisplatin and concurrent radical radiation (20/25) or intraarterial cisplatin, concurrent preoperative radiation, and cystectomy (5/25). One patient died from treatment-related toxicity. Other toxicities have been what one would expect from the individual treatment modalities except for a sensory sacral root neuropathy in 11 of 24 (46%) patients. Twenty-three of 24 (96%) patients achieved a complete response (CR) and the projected actuarial 2-year survival is 90%. Only one of the 23 complete responders has had an invasive local recurrence. The excellent complete local response and survival rates achieved warrant further study of the combination of intraarterial cisplatin and radiation as a bladder-preserving strategy.     

T1G3膀胱尿路上皮癌保留膀胱综合治疗的疗效评价

 目的 探讨保留膀胱的局部切除联合动脉化疗治疗T1G3膀胱尿路上皮癌的疗效。 方法　对35例T1G3膀胱尿路上皮癌患者行保留膀胱的肿瘤切除,术后辅助3次动脉化疗,所有患者均行规范膀胱灌注化疗。 结果　35例患者术后随访7～116个月,平均随访（66.0±18.3）个月,术后5年肿瘤复发率48.6 %（17／35）,膀胱保留率68.6 %（24／35）,总生存率77.1 ％（27／35）,肿瘤特异性生存率82.9 ％（29／35）,动脉化疗无严重并发症发生。结论　T1G3膀胱尿路上皮癌保留膀胱综合治疗不但可以维持正常的膀胱功能,降低复发率,而且不会降低患者的生存率,是可选择的有效治疗手段,避免部分患者行膀胱全切的过度治疗。     

Risk factors for intravesical recurrence following urothelial carcinoma of the upper urinary tract: no relationship to the mode of surgery

OBJECTIVE: The aim of this study was to clarify whether intravesical recurrence of upper urinary tract cancer after treatment is related to the mode of surgery or other oncological factors. METHODS: We evaluated 106 patients (mean age 70.4 years; mean follow-up 24.0 months) who underwent surgery for the upper urinary tract cancer at Hiroshima University and its affiliated hospitals between January 1995 and August 2005. Seventy-nine of the patients underwent retroperitoneoscopy-assisted radical nephroureterectomy (RN) and 27 underwent nephroureterectomy by open surgery (OS). Fifty-two patients had renal pelvic tumors, 48 had ureteral tumors, and six had both renal pelvic and ureteral tumors. Twenty-eight (26%) of the 106 patients had a pre-operative history of bladder cancer. We identified the risk factors predicting intravesical recurrence of upper urinary tract cancer according to the type of previous surgery using the Kaplan-Meier method, log-rank test, and univariate and multivariate analysis using the Cox proportional hazards model. RESULTS: Thirty-one (29%) of the 106 patients developed bladder tumors post-operatively. The 2-year intravesical recurrence-free rate was 55% in the RN group and 60% in the OS group. There was no significant difference (P = 0.51, log-rank test) in the rate of intravesical recurrence between the two groups. Multivariate analysis identified only a history of pre-operative bladder tumor (HR = 3.25, P = 0.003) as a predictor of post-operative intravesical recurrence. CONCLUSIONS: Intravesical recurrence after surgery for upper urinary tract cancer is not related to the mode of surgery (i.e. laparoscopy-assisted or open surgery) employed. The only risk factor for intravesical recurrence is a history of bladder cancer.     

Proton beam therapy for invasive bladder cancer: a prospective study of bladder-preserving therapy with combined radiotherapy and intra-arterial chemotherapy

PURPOSE: To present outcomes of bladder-preserving therapy with proton beam irradiation in patients with invasive bladder cancer. METHODS AND MATERIALS: Twenty-five patients with transitional cell carcinoma of the urinary bladder, cT2-3N0M0, underwent transurethral resection of bladder tumor(s), followed by pelvic X-ray irradiation combined with intra-arterial chemotherapy with methotrexate and cisplatin. Upon completion of these treatments, patients were evaluated by transurethral resection biopsy. Patients with no residual tumor received proton irradiation boost to the primary sites, whereas patients demonstrating residual tumors underwent radical cystectomy. RESULTS: Of 25 patients, 23 (92%) were free of residual tumor at the time of re-evaluation; consequently, proton beam therapy was applied. The remaining 2 patients presenting with residual tumors underwent radical cystectomy. Of the 23 patients treated with proton beam therapy, 9 experienced recurrence at the median follow-up time of 4.8 years: local recurrences and distant metastases in 6 and 2 patients, respectively, and both situations in 1. The 5-year overall, disease-free, and cause-specific survival rates were 60%, 50%, and 80%, respectively. The 5-year local control and bladder-preservation rates were 73% and 96%, respectively, in the patients treated with proton beam therapy. Therapy-related toxicities of Grade 3-4 were observed in 9 patients: hematologic toxicities in 6, pulmonary thrombosis in 1, and hemorrhagic cystitis in 2. CONCLUSIONS: The present bladder-preserving regimen for invasive bladder cancer was feasible and effective. Proton beam therapy might improve local control and facilitate bladder preservation.     

Prognostic factors in invasive bladder carcinoma in a prospective trial of preoperative adjuvant chemotherapy and radiotherapy

Clinical and pathologic factors were analyzed in 40 patients with localized muscle-invasive bladder carcinoma treated in a prospective bladder-preserving program consisting of transurethral tumor resection, neoadjuvant chemotherapy (methotrexate, cisplatin, and vinblastine [MCV]), and 4,000 cGy radiotherapy with concurrent cisplatin. Patients with biopsy-proven complete response after chemotherapy and 4,000 cGy radiation received full-dose radiotherapy (6,480 cGy) with cisplatin. Cystectomy was recommended to patients with residual disease. Distant metastasis rate was associated with tumor stage and size: 0% in T2 patients, 39% in T3-4 patients (P = .035), 6% for tumors less than 5 cm, and 59% for tumors greater than or equal to 5 cm (P = .002). Risk of bladder tumor recurrence was higher in patients with tumor-associated carcinoma in situ (CIS; 40%) than those without CIS (6%; P = .075). Papillary tumors and solid tumors both had similar treatment outcomes. By multivariate analysis, tumor stage T2 (P = .04) and absence of CIS (P = .03) were significant predictors of complete response; CIS was predictive of local bladder recurrence (P = .07); and tumor size (P = .03), response after chemoradiotherapy (P = .02), and vascular invasion (P = .08) were associated with distant metastasis. Six of eight local bladder tumor recurrences were superficial tumors. The low actuarial distant metastasis rate of T2 patients (0% at 3 years), the 3-year actuarial overall survival rates for T2 (89%) and T3-4 (50%) patients, and the similar treatment outcomes for papillary versus solid tumors are encouraging when compared with published historical controls. These results provide preliminary evidence (median follow-up, 30 months) that the current chemoradiotherapy regimen may have beneficial effects in the treatment of muscle-invasive bladder carcinoma. The true efficacy of neoadjuvant chemotherapy remains to be proven by ongoing randomized trials.     

丝裂霉素C加透明质酸酶膀胱灌注预防膀胱癌复发的疗效观察

 目的观察丝裂霉素C加透明质酸酶膀胱内灌注预防膀胱癌复发的疗效。方法88例膀胱癌患者随机分为两组丝裂霉素C加透明质酸酶组46例,在肿瘤切除术后应用丝裂霉素C20mg加透明质酸酶3000U定期膀胱内灌注。对照组42例,术后单纯应用丝裂霉素C20mg定期膀胱内灌注。观察两组肿瘤复发情况。结果经随访12～36个月,平均24.5个月,丝裂霉素C加透明质酸酶组肿瘤复发率为10.9%,单纯丝裂霉素C组肿瘤复发率为31.0%,两组比较,差异有显著性(P<0.05)。结论丝裂霉素C加透明质酸酶膀胱内灌注能更有效地预防膀胱癌的术后复发。