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。

Results of treatment of multimodality therapy following bladder-preserving surgery for muscle-invasive bladder cancer

Objective To evaluate the local control effect of radiotherapy and intravesical chemotherapy following bladder preserving surgery for musculoinvasive bladder cancer. Methods Twenty three patients with muscle invasive bladder cancer were treated by bladder preserving surgery followed by external radiation ( mean dose 52.5 Gy) combined with intravesical mitomycin infusion after bladder preserving operation (study group).For comparison, 29 similar patients received the same treatment without radiation served as control (control group).Results All patients in the study group completed their designed treatment,except two patients whose protocol was interrupted for 3 days and one week due to acute cystitis. The mean follow up duration was 41.6 months. The 3 year local recurrence rates were 18.8% in the study group and 44.8% in the control group(P=0.026).The 3 year distant metastasis rates were 18.2% and 24.1% (P=0.437),and the 3 year overall survival rates were 81.8% and 86.2% (P=0.670),respectively. Conclusion It is demonstrated that adjuvant radiotherapy and intravesical infusion chemotherapy following organ preserving surgical procedure are encouraging by giving favorable local control for musculoinvasive bladder cancer.