CAJ | 학술논문

目的评价动脉介入化疗、适形放疗联合绿激光治疗肌层浸润性膀胱癌的疗效及安全性. 方法 2009年11月至2012年11月对16例无法耐受或不接受膀胱全切手术的肌层浸润性膀胱癌患者采用动脉介入化疗、适形放疗联合绿激光治疗.男13例,女3例.年龄63 ～ 86岁,平均74岁.病程10 d～3个月.临床分期为T2期9例、T3期7例,肿瘤分级G13例、G210例、G33例.肿瘤直径3～6 cm,平均3.5 cm.合并较严重心脑血管疾病11例,重度肺通气功能障碍3例,要求保留膀胱2例.化疗药物包括顺铂80 mg、吡柔比星40 mg;放疗采用三维适形定位,总剂量30～ 40 Gy;首次介入化疗后2个月采用绿激光行肿瘤汽化手术. 结果放化疗后所有患者肿瘤明显坏死、缩小,5例肿瘤消失.激光治疗后随访3～43个月,2例复发,行再次绿激光汽化.2例死于脑血管意外.结论动脉介入化疗、适形放疗联合绿激光治疗浸润性膀胱癌安全,疗效确实,对于老年、合并症多的患者或不愿接受膀胱全切的患者,是一个很好的选择.
목적 평개동맥개입화료、괄형방료연합록격광치료기층침윤성방광암적료효급안전성. 방법 2009년11월지2012년11월대16례무법내수혹불접수방광전절수술적기층침윤성방광암환자채용동맥개입화료、괄형방료연합록격광치료.남13례,녀3례.년령63 ～ 86세,평균74세.병정10 d～3개월.림상분기위T2기9례、T3기7례,종류분급G13례、G210례、G33례.종류직경3～6 cm,평균3.5 cm.합병교엄중심뇌혈관질병11례,중도폐통기공능장애3례,요구보류방광2례.화료약물포괄순박80 mg、필유비성40 mg;방료채용삼유괄형정위,총제량30～ 40 Gy;수차개입화료후2개월채용록격광행종류기화수술. 결과 방화료후소유환자종류명현배사、축소,5례종류소실.격광치료후수방3～43개월,2례복발,행재차록격광기화.2례사우뇌혈관의외.결론 동맥개입화료、괄형방료연합록격광치료침윤성방광암안전,료효학실,대우노년、합병증다적환자혹불원접수방광전절적환자,시일개흔호적선택.
Objective To evaluate the efficacy of bladder preservation treatment by combining intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization for muscle-invasive bladder cancer.Methods A total of 16 patients (13 males and 3 females; mean age,74 years; age range,68-86 years) with muscle-invasive bladder cancer underwent bladder preservation treatment,who refused or could not tolerate the radical cystectomy (11 cases with cardiovascular and cerebrovascular disease,3 cases with severe chronic obstructive pulmonary disease and other 2 cases refused radical cystectomy as initial therapeutic option).The tumor stages were T2(9 cases),T3(7 cases) and tumor grades were G1(3 cases),G2(10 cases) and G3(3 cases).The mean diameter of tumor was 3.5 cm (range from 3 cm to 6 cm).They received intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization.The chemotherapy regimen consisted of cisplatin 80 mg and pirarubicin 40 mg.The average dose of radiotherapy was 30-40 Gy.Results After intraarterial chemotherapy and three dimensional conformal radiotherapy,all the tumors were necrosis and dwindled significantly and 5 patients showed a complete response.The patients were follow up for 3-43 months after transurethral photoselective vaporization of the residual tumor.Recurrent non-muscle invasive tumors were found in 2 patients and were treated transurethrally.Overall,2 patients died of cerebrovascular accident.Conclusion Combination of intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization is safe and effective for the treatment of muscle-invasive bladder cancer.