국소 진행성 방광이행상피세포암의 방광보존요법

Abstract

Twenty three patients with locally invasive transitional cell carcinoma of the bladder(stage T2-T4N0M0) who refused to undergo radical cystectomy or were poor surgical candidates were included in this study. All patients received transurethral resection(TUR) of the tumor initially for the pathologic staging and debulking of tumor mass. Then, patients were treated with either one of the following two bladder preservation protocols. First trials consisted of initial 2 courses of MVAC(methotrexate, vinblastin, adriamycin and cisplatin) chemotherapy and followed by radiotherapy( 6480cGy) plus 2 courses of cisplatin. The other protocol was initial radiotherapy ( 6480cGy) with 2 courses of cisplatin and additional 2 courses of MCV(methotrexate, cisplatin and vinblastin) chemotherapy. There were 8 patients in T2, 13 in T3 and 2 in T4. Repeat biopsies were conducted 1 to 6 months after initiation of therapy. With a mean follow up of 17.1 months, other than two patients who underwent cystectomies, the survival rate without local recurrence or distant metastasis was 66.6% (14/21)-87.5 % ( 7/8) in T2. 63.6 % ( 7/11) in T3 and 0%(0/2) in T4. Bladder tumor recurrence and metastasis was observed in 3 patients respectively. One patient in stage T4 died at 20 months with multiple metastasis. The survival rate is closely correlated to initial stage. Patients with no residual mass after TUR seemed to be better in response than patients with residual mass. Side reactions such as neutropenia ( <2000/ mm3) were observed in 6(26.2% ) patients, radiation cystitis in 2(8.7% ) and radiation proctitis in 1(4.3%) The bladder preservation protocol in locally invasive bladder tumor has relatively satisfactory results but longer follow-up is necessary to determine the efficacy of current protocol in long term survival.