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目的探讨放疗结合吉西他滨和顺铂同步化疗膀胱癌全膀胱切除术后复发病人的副反应及疗效。方法对29例膀胱癌全膀胱切除术后复发病人进行放、化同步治疗,平均年龄61岁。照射剂量 DT 49.5～65.5Gy,中位54.6 Gy,放疗同时给予吉西他滨800 mg/m~2第1、8天,顺铂25 mg/m~2分别于第1、2、3天静脉滴注。结果Ⅲ～Ⅳ级骨髓抑制4例,Ⅱ～Ⅲ放射性肠炎4例,全组总有效率(CR+PR)69.0%。中位随访期19个月,中位生存期13个月,总的1年、2年存活率分别为53.9%和20.5%。放疗剂量>54.6,Gy≤54.6 Gy,中位生存期分别为9.3,20.3个月(P<0.05)。29例中死亡27例,23例死于肿瘤,其中15例死于治疗后第二年。结论膀胱癌全膀胱切除术后复发,预后较差,行吉西他滨加顺铂同步放、化疗的副反应可接受,具有较好近期及远期疗效。失败原因是远地转移。
Objective To investigate the side effects and efficacy of concurrent radiotherapy combined with gemcitabine and cisplatin in patients with recurrent bladder cancer after cystectomy. Methods Twenty-nine patients with recurrent bladder cancer after total cystectomy were treated with radiotherapy and concurrent treatment, with an average age of 61 years. Radiation dose DT 49.5 ~ 65.5Gy, median 54.6 Gy, radiotherapy given gemcitabine 800 mg / m ~ 2 on the 1st and the first days, cisplatin 25 mg / m ~ 2 were intravenously dripped on days 1,2,3. Results There were 4 cases of grade Ⅲ ~ Ⅳ myelosuppression and 4 cases of Ⅱ ~ Ⅲ radiation enteritis. The total effective rate (CR + PR) was 69.0%. The median follow-up period was 19 months and the median survival time was 13 months. The total 1-year and 2-year survival rates were 53.9% and 20.5% respectively. Radiotherapy dose> 54.6, Gy≤54.6 Gy, median survival was 9.3 and 20.3 months (P <0.05). Of the 29 patients, 27 died and 23 died of tumors, of which 15 died the second year after treatment. Conclusions The recurrence of bladder cancer after total cystectomy has a poor prognosis. Side effects of gemcitabine plus cisplatin and concurrent chemotherapy and chemotherapy are acceptable with good short-term and long-term effects. The reason for the failure is remote transfer.