保留膀胱的放疗同步小剂量吉西他滨化疗对肌层浸润性膀胱癌的疗效

摘要

目的:探讨保留膀胱的放疗同步小剂量吉西他滨(GEM)化疗对肌层浸润性膀胱癌(MIBC)患者的疗效.方法:回顾性分析63例MIBC患者的临床资料.其中,34例行保留膀胱的综合治疗(观察组),29例行单纯放射治疗(对照组).两组患者均接受经尿道膀胱肿瘤电切术(TURBT),术后观察组采用常规分割的方式行膀胱根治性放射治疗,并从放疗第1天开始接受75 mg/m2的小剂量GEM同步化疗;对照组术后仅进行膀胱根治性放疗.观察并比较两组的近期疗效、2年生存率及不良反应发生率.结果:观察组近期临床疗效有效率为79.4％,高于对照组55.2％(P＜0.05);观察组与对照组3～4度不良反应发生率相比无统计学差异(44.1％ vs27.6％,P=0.174);观察组和对照组的2年总生存时间比较无统计学差异(P=0.752),其2年无进展生存时间相比有明显差异(P=0.043).结论:对于MIBC患者TURBT术后行膀胱根治性放疗同步小剂量GEM化疗,与单纯放疗相比可显著提高无病生存率,降低局部复发及进展的可能,且不良反应发生率无明显差异.%Objective:To detect the efficacy of the bladder-sparing synchronous chemotherapy with low-dose gemcitabine (GEM)chemotherapy combined with radiotherapy in treatment of local muscle-invasive bladder cancer(MIBC).Methods:Sixty-three MIBC cases were treated by TURBT.Thirty-four cases (observation group) underwent the bladder-sparing synchronous chemotherapy with GEM at 75 mg/m2 per week combined with radiotherapy.Twenty-nine cases (control group) underwent radiotherapy without chemotherapy.PFS and OS after 2 years were compared,together with short-term efficiency and toxic effects.Results:At 2 years,rates of PFS were 73.5％ in the observation group and 48.3％ in the control group,with statistical differences between them (P=0.043).Short-term efficiency were 79.4％and 55.2％ in the observation group and control group,with significant differences.There were no significant differences between observation group and control group in the OS (79.4％ vs 75.9％,P＞0.05) and toxic effects (44.1％ vs 27.6％,P＞0.05).Conclusion:The bladder-sparing synchronous chemotherapy with low-dose GEM combined with radiotherapy can significantly improve locoregional control of MIBC,as compared to radiotherapy alone,with no significant increase in adverse events.