摘要:
目的 :探讨术后膀胱灌注、加温和放射治疗膀胱癌的综合治疗方案。 方法 :术后灌注(A)组134例;术后灌注加温(B)组106例;术后灌注放疗(C)组176例。术后3周膀胱内灌注噻替哌50～60mg/次,1～2次/w,共10～12次或丝裂霉素20mg,1次/w,连用6～8次。使用8、10或18MV高能X射线,照射剂量30～60Gy;加温在灌注后1小时内进行,每次30～40分钟。 结果 :A、B、C组5、10和15年生存率分别为58.2%、58.5%、72.7%;26.9%、27.4%、44.9%和5.9%、8.2%、18.4%;各组T1期与T2和T3期生存率均有显著性差异,字X2=6.27,P<0.05。A、B和C组5、10和15年生存者膀胱保留率分别为53.8%、69.4%、81.3%;19.4%、24.1%、51.9%;、0、0和37.5%。 结论 :术后膀胱灌注加放疗治疗膀胱癌在提高肿瘤局控率、降低盆腔复发率、提高膀胱保存率和远期疗效均明显高于膀胱灌注和灌注加温组。
Abstract:
Objective :To evaluate and optimize synthesizing regimen for postoperative bladder cancer. Methods :One hundred and thirty-four patients were treated with intravesical chemotherapy alone,106 with intravesical chemotherapy plus hyperthermia,176 with intravesical chemotherapy and radiotherapy post-operatively.The intravesical chemotherapy was given 3 weeks after operation,with thio-TEPA 50~60mg/fraction,using 6 to 8 fractions.For radiotherapy,8,10 or 18 MY X-ray was given with total dose of 30~60Gy.Hyperthermia was performed in 1 hour, with intravesical chemotherapy,and each fraction costed about 30 or 40 min. Results :The 5,10 and 15-year survival rate for group A,B abd C were 58.2%,58.5W and 72.7%(A),26.9%,27.4W and 44.9% (B),and 5.9%,8.2W and 18.4W (C),respectively.There was significant difference between T1 and T2/T3 stages at each group,P<0.05.The rate of preserving bladder in group A,B and C for 5,10 and 15 years were 53.8%,69.4%,and 81.3%(A),19.4%,24.1% and 51.9%(B),0,0 and 37.5%(C),respectively. Conclusion :The intravesical chemotherapy and radiotherapy for postoperative bladder cancer patients can enhance local control rate,dicrease recurrent rate in pelvic,raise the rate of preversing bladder and improve the long-term survival.
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