新辅助放疗联合RPVBT及辅助化疗治疗MIBC的研究

发布时间：2018-05-13 05:42

本文选题：肌层浸润性膀胱癌 + 新辅助放疗　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:分析新辅助放疗联合根治性绿激光汽化术(radical photoselective vaporization of bladder tumors,RPVBT)及辅助化疗的治疗模式与传统膀胱癌根治术(radical cystectomy,RC)对于肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)的临床疗效,比较两组患者术后围手术期并发症、生存率以及生活质量的差异,探索MIBC患者保留膀胱治疗的新方法。方法:收集2008年3月至2012年3月期间天津市人民医院收治的207例肌层浸润性膀胱癌患者的临床资料,筛选影像学检查及膀胱镜活检证实为T2~T3a期并符合入排标准的MIBC患者143例,依据患者接受的治疗方案分为RPVBT组和传统根治组,其中RPVBT组纳入87例,而传统根治组纳入56例。RPVBT组患者术前接受新辅助适形调强放疗(IMRT,44~50Gy/25~30次/5~6周),并根据患者耐受程度,于放疗结束后4~6周行RPVBT术,术后给予患者4~6周期的吉西他滨联合顺铂(GC方案)辅助化疗。传统根治组MIBC患者则常规行全膀胱切除加淋巴结清扫术,术后病理p T3a伴淋巴结转移者给予GC方案化疗。收集两组患者围手术期并发症、生存及复发情况的相关信息,并评估两组患者不同时间点生活质量量表(膀胱肿瘤特异性调查表Functional Assessment of Cancer Therapy-Bladder,FACT-BL,见附录),比较两组患者术后生存情况、肿瘤复发率、并发症及生活质量,探讨两种治疗方式的疗效差异。结果:RPVBT组患者接受新辅助放疗后部分患者肿瘤体积明显缩小甚至消失,其有效率(完全缓解+部分缓解)达到77.0%(67/87);新辅助放疗对胃肠道干扰小,主要的并发症为放射性膀胱炎。RPVBT组患者术后严重并发症发生率(16.1%)显著低于传统手术组(44.6%)。RPVBT组术后1、2、3、4、5年生存率分别为96.6%、88.5%、70.1%、57.5%、44.8%;传统传统根治组术后1、2、3、4、5年生存率分别为92.9%、85.7%、69.6%、67.9%、66.1%,统计学分析结果显示RPVBT组与传统根治组患者术后生存率无显著统计学差异(P=0.665)。通过生活质量问卷调查表发现:所有MIBC患者术后3、6、12、24、36、48、60个月患者FACT-BL评分表现出逐渐递增趋势,RPVBT组评分显著高于传统根治组患者(P=0.01)。结论:与传统膀胱癌根治术相比,新辅助放疗联合RPVBT及术后辅助化疗术后严重并发症发生率低,而总体生存率无显著差异,并且患者术后生活质量明显高于传统根治手术。由此可见,新辅助放疗联合RPVBT及术后GC方案辅助化疗是T2~T3a期肌层浸润性膀胱癌患者保留膀胱治疗的新的治疗模式。
[Abstract]:Objective: to analyze the therapeutic effects of neoadjuvant radiotherapy combined with radical green laser vaporization (RPV) and adjuvant chemotherapy in the treatment of muscle invasive bladder carcinoma of bladder. To compare the difference of perioperative complications, survival rate and quality of life between the two groups, and to explore a new method of bladder retention therapy in patients with MIBC. Methods: the clinical data of 207 patients with myometrial invasive bladder cancer admitted to Tianjin people's Hospital from March 2008 to March 2012 were collected. 143 cases of MIBC confirmed by imaging examination and cystoscopic biopsy were confirmed as T2~T3a and in accordance with the admission criteria. The patients were divided into RPVBT group and traditional radical therapy group according to the treatment plan, including 87 cases in RPVBT group and 56 cases in traditional radical mastectomy group. 56 patients in traditional radical mastectomy group received neoadjuvant conformal intensity modulated radiotherapy before operation. RPVBT was performed 4 ~ 6 weeks after radiotherapy. Patients were treated with gemcitabine plus cisplatin GC regimen for 4 ~ 6 cycles. In the traditional radical group, the patients with MIBC were treated with total cystectomy and lymph node dissection. The patients with postoperative pathological pT3a and lymph node metastasis were treated with GC regimen chemotherapy. To collect information about perioperative complications, survival and recurrence in both groups, The quality of life (QOL) scale (Functional Assessment of Cancer Therapy-Bladderdern FACT-BLS) at different time points was evaluated. The survival status, tumor recurrence rate, complications and quality of life were compared between the two groups. To explore the difference of curative effect between two kinds of treatment methods. Results after neo-adjuvant radiotherapy, the tumor volume decreased or even disappeared in some of the patients in the RPVBT group, and the effective rate (complete remission) reached 77.067 / 87, and the neoadjuvant radiotherapy had little interference with gastrointestinal tract. The main complications were the incidence of severe postoperative complications in the radiation-cystitis .RPVBT group (16.1) significantly lower than that in the traditional operation group (44.6U 路RPVBT group). The 5-year survival rate was 96.688. 50.1% and 57.5%, respectively, and the 5-year survival rate was 92.95.79.69.69.69.69.67.90.The 5-year survival rate was 92.95.79.69.69.69.67.9and 66.1respectively, and the 5-year survival rate was 92.95.79.69.69.66.1. The results showed that there was no significant difference in the postoperative survival rate between the RPVBT group and the traditional radical group. Through the quality of life questionnaire, we found that all the patients with MIBC showed a gradual increasing trend of FACT-BL score at 60 months after operation. The FACT-BL score in all patients with MIBC was significantly higher than that in the traditional radical cure group. Conclusion: compared with conventional radical resection of bladder cancer, the incidence of severe complications after neoadjuvant radiotherapy combined with RPVBT and postoperative adjuvant chemotherapy is lower, but the overall survival rate is not significantly different, and the postoperative quality of life of the patients is significantly higher than that of traditional radical surgery. Therefore, neoadjuvant radiotherapy combined with RPVBT and postoperative GC regimen adjuvant chemotherapy is a new mode of bladder retention therapy in patients with T2~T3a stage myometrial invasive bladder cancer.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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