新辅助与辅助膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌的疗效对比
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摘要
目的探讨经尿道膀胱肿瘤电切术(TURBT)术前新辅助膀胱热灌注化疗对比术后辅助膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌的疗效。方法收集经尿道膀胱肿瘤电切术术前或术后使用BR-TRG-Ⅱ型体腔热灌注治疗仪行吉西他滨膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌患者40例,其中16例行术前(吉西他滨1000 mg,45℃,45 min)新辅助膀胱热灌注化疗3次,隔天一次,治疗结束后3～7天行经尿道膀胱肿瘤电切术,定义为新辅助组;另外24例患者先行TURBT手术,术后即刻或者隔天(吉西他滨1000 mg,45℃,45 min)行辅助膀胱热灌注化疗,定义为辅助组。记录并比较两组患者无疾病复发生存期(RFS)以及不良反应。结果全部40例患者均完成3次吉西他滨膀胱热灌注化疗,新辅助组患者中,完全缓解(p T0)11例(68.8%),部分缓解5例(31.2%)。新辅助组中位无复发生存期为54月,辅助组中位无复发生存期为45月,两者比较差异无统计学意义(P=0.3146)。两组患者不良反应可耐受。结论无论是新辅助还是辅助治疗,使用BR-TRG-Ⅱ型体腔热灌注治疗仪行吉西他滨膀胱热灌注化疗治疗高危非肌层浸润性膀胱癌安全有效。
Objective To analyze the effectiveness of neoadjuvant and adjuvant bladder intracavitary hyperthermic perfusion chemotherapy(BHPC) on high-risk non-muscle-invasive bladder cancer(NMIBC)patients. Methods We included 40 patients with high-risk NMIBC who received BHPC treatment with a "BR-TRG-Ⅱ type high-precision hyperthermic intraperitoneal perfusion treatment system" before or after transurethral resection of the bladder tumor(TURBT). Among these patients, 16 patients received neoadjuvant BHPC treatment(gemcitabine 1000 mg three instillations every other day, 45℃, 45 min) before TURBT(neoadjuvant group) and 24 patients received adjuvant BHPC treatment(gemcitabine 1000 mg three instillations every other day, 45℃, 45 min) after TURBT(adjuvant group). Disease recurrence free survivals(RFS) and adverse effects were evaluated between both groups. Results A total of 40 patients completed three times of gemcitabine therapy. In neoadjuvant group, 11 patients(68.8%) showed a complete response(p T0) and 5 patients(32.2%) showed a partial response. The median RFS was 54 months. In adjuvant group,the median RFS was 45 months. The difference of survival rate between them was not statistically significant(P=0.3146). The incidence and severity of side effects were mild in both two groups. Conclusion BHPC on high-risk NMIBC patients using a "BR-TRG-Ⅱ type high-precision hyperthermic intraperitoneal perfusion treatment system" is safe and effective in both neoadjuvant and adjuvant settings.
Objective To analyze the effectiveness of neoadjuvant and adjuvant bladder intracavitary hyperthermic perfusion chemotherapy(BHPC) on high-risk non-muscle-invasive bladder cancer(NMIBC)patients. Methods We included 40 patients with high-risk NMIBC who received BHPC treatment with a "BR-TRG-Ⅱ type high-precision hyperthermic intraperitoneal perfusion treatment system" before or after transurethral resection of the bladder tumor(TURBT). Among these patients, 16 patients received neoadjuvant BHPC treatment(gemcitabine 1000 mg three instillations every other day, 45℃, 45 min) before TURBT(neoadjuvant group) and 24 patients received adjuvant BHPC treatment(gemcitabine 1000 mg three instillations every other day, 45℃, 45 min) after TURBT(adjuvant group). Disease recurrence free survivals(RFS) and adverse effects were evaluated between both groups. Results A total of 40 patients completed three times of gemcitabine therapy. In neoadjuvant group, 11 patients(68.8%) showed a complete response(p T0) and 5 patients(32.2%) showed a partial response. The median RFS was 54 months. In adjuvant group,the median RFS was 45 months. The difference of survival rate between them was not statistically significant(P=0.3146). The incidence and severity of side effects were mild in both two groups. Conclusion BHPC on high-risk NMIBC patients using a "BR-TRG-Ⅱ type high-precision hyperthermic intraperitoneal perfusion treatment system" is safe and effective in both neoadjuvant and adjuvant settings.
引文
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[14]Babjuk M,B?hle A,Burger M,et al.EAU Guidelines on NonMuscle-invasive Urothelial Carcinoma of the Bladder:Update2016[J].Eur Urol,2017,71(3):447-61.
[15]Arends TJ,Nativ O,Maffezzini M,et al.Results of a Randomised Controlled Trial Comparing Intravesical Chemohyperthermia with Mitomycin C Versus Bacillus Calmette-Guerin for Adjuvant Treatment of Patients with Intermediate-and High-risk NonMuscle-invasive Bladder Cancer[J].Eur Urol,2016,69(6):1046-52.
[16]Sousa A,Inman BA,Pi?eiro I,et al.A clinical trial of neoadjuvant hyperthermic intravesical chemotherapy(HIVEC)for treating intermediate and high-risk non-muscle invasive bladder cancer[J].Int J Hyperthermia,2014,30(3):166-70.
[17]Ekin RG,Akarken I,Cakmak O,et al.Results of Intravesical Chemo-Hyperthermia in High-risk Non-muscle Invasive Bladder Cancer[J].Asian Pac J Cancer Prev,2015,16(8):3241-5.
[2]Hizli F,Argun G,Guney I,et al.Obturator nerve block transurethral surgery for bladder cancer:comparison of inguinal and intravesical approaches:prospective randomized trial[J].Ir JMed Sci,2016,185(3):555-60.
[3]Chamie K,Litwin MS,Bassett JC,et al.Recurrence of high-risk bladder cancer:a population-based analysis[J].Cancer,2013,119(17):3219-27.
[4]Sousa A,Pi?eiro I,Rodriguez S,et al.Recirculant hyperthermic IntraVEsical chemotherapy(HIVEC)in intermediate-high-risk non-muscle-invasive bladder cancer[J].Int J Hyperthermia,2016,32(4):374-80.
[5]Ba M,Cui S,Wang B,et al.Bladder intracavitary hyperthermic perfusion chemotherapy for the prevention of recurrence of nonmuscle invasive bladder cancer after transurethral resection[J].Oncol Rep,2017,37(5):2761-70.
[6]Inman BA,Etienne W,Rubin R,et al.The impact of temperature and urinary constituents on urine viscosity and its relevance to bladder hyperthermia treatment[J].Int J Hyperthermia,2013,29(3):206-10.
[7]Arends TJ,van der Heijden AG,Witjes JA.Combined Chemohyperthermia:10-Year Single Center Experience in 160Patients with Nonmuscle Invasive Bladder Cancer[J].J Urol,2014,192(3):708-13.
[8]Schooneveldt G,Bakker A,Balidemaj E,et al.Thermal dosimetry for bladder hyperthermia treatment.An overview[J].Int JHyperthermia,2016,32(4):417-33.
[9]G?zen AS,Umari P,Scheitlin W,et al.Effectivity of intravescical thermo-chemotherapy prophylaxis for patients with high recurrence and progression risk for non-muscle invasive bladder cancer[J].Arch Ital Urol Androl,2017,89(2):102-5.
[10]Milla P,Fiorito C,Soria F,et al.Intravesical thermochemotherapy based on conductive heat:a first pharmacokinetic study with mitomycin C in superficial transitional cell carcinoma patients[J].Cancer Chemother Pharmacol,2014,73(3):503-9.
[11]Liem EI,Crezee H,de la Rosette JJ,et al.Chemohyperthermia in non-muscle-invasive bladder cancer:An overview of the literature and recommendations[J].Int J Hyperthermia,2016,32(4):363-73.
[12]J?rvinen R,Marttila T,Kaasinen E,et al.Long-term outcome of patients with frequently recurrent non-muscle-invasive bladder carcinoma treated with one perioperative plus four weekly instillations of mitomycin C followed by monthly bacillus Calmette-Guerin(BCG)or alternating BCG and interferonalpha2b instillations:prospective randomised FinnBladder-4study[J].Eur Urol,2015,68(4):611-7.
[13]Lammers RJ,Witjes JA,Inman BA,et al.The role of a combined regimen with intravesical chemotherapy and hyperthermia in the management of non-muscle-invasive bladder cancer:a systematic review[J].Eur Urol,2011,60(1):81-93.
[14]Babjuk M,B?hle A,Burger M,et al.EAU Guidelines on NonMuscle-invasive Urothelial Carcinoma of the Bladder:Update2016[J].Eur Urol,2017,71(3):447-61.
[15]Arends TJ,Nativ O,Maffezzini M,et al.Results of a Randomised Controlled Trial Comparing Intravesical Chemohyperthermia with Mitomycin C Versus Bacillus Calmette-Guerin for Adjuvant Treatment of Patients with Intermediate-and High-risk NonMuscle-invasive Bladder Cancer[J].Eur Urol,2016,69(6):1046-52.
[16]Sousa A,Inman BA,Pi?eiro I,et al.A clinical trial of neoadjuvant hyperthermic intravesical chemotherapy(HIVEC)for treating intermediate and high-risk non-muscle invasive bladder cancer[J].Int J Hyperthermia,2014,30(3):166-70.
[17]Ekin RG,Akarken I,Cakmak O,et al.Results of Intravesical Chemo-Hyperthermia in High-risk Non-muscle Invasive Bladder Cancer[J].Asian Pac J Cancer Prev,2015,16(8):3241-5.