吉西他滨膀胱灌注治疗复发性浅表性膀胱肿瘤的安全性与有效性

目的 评价吉西他滨膀胱灌注化疗治疗常规膀胱灌注化疗(包括丝裂霉素、表阿霉素和羟基喜树碱)失败的非肌层浸润性膀胱癌(NMIBC)的安全性及有效性.方法 将72例在持续常规膀胱灌注化疗1年内出现肿瘤复发的NMIBC患者分为A、B、C 3组,每组24例.A组给予吉西他滨1000 mg灌洗,B组给予吉西他滨2000 mg灌洗,C组继续采用原化疗方案灌洗.观察并记录肿瘤复发时间及化疗不良反应.结果 A、B、c组患者的2年肿瘤无复发生存率分别为66.7%、75.0%和45.8%,采用吉西他滨灌洗患者的2年无瘤生存率达70.8%,显著高于传统化疗方案(45.8%,P<0.05),但A组与B组间未见明显差异.A组与B组中各有I例患者发生肾功能不全,其余不良反应主要为尿频、尿急、尿痛、血尿等,经对症治疗后缓解,各组间未见有明显差异,未发生严重的血液学不良反应.结论 对于常规膀胱灌注化疗后复发的NMIBC患者可考虑采用吉西他滨膀胱灌注化疗,但需注意观察患者的肾功能改变.

Evaluation of the efficacy and safety of intravesical instillation with gemcitabine after first-line intravesical chemotherapy failure in the treatment of non-muscle-invasive bladder cancer

Objective To evaluate the efficacy and safety of intravesical instillation with gemcitabine after first-line intravesical chemotherapy failure, including mitomycin ( MMC), epirubicin (EPB) and camptothecin- (CPT), in the treatment of non-muscle-invasive bladder cancer (NMIBC). Methods From June 2007 to October 2008, 72 patients with NMIBC, who had tumor recurrence within one year of first-line intravesical chemotherapy, were assigned to 3 groups (24 cases each). Croup A received intravesical gemcitabine in a dose of 1000 mg, Group B received 2000 mg gemcitabine, and Group C received original intravesical chemotherapy. The time of reccurrence and adverse effects were recorded. Results The 2-year tumor free survival rates of the 3 groups were 66.7% , 75.0% and 45.8% , respectively. The 2-year TFS rate of the patients who received gemcitabine was 70.8% , significantly higher than 45.8% of the patients treated by original chemotherapy. There was one case with renal function impairement in the groups A and B, respectively. There was no significant difference between the rates of low urinary tract symptoms in the 3 groups. No severe hematological side effects were observewd in this study. Conclusion The intravescal chemotherapy with gemcitabine in patients with recurrent bladder tumor after first-line intravesical chemotherapy is effective and well tolerated, however, renal function should be routinely assessed.