Clinical Outcomes of Advanced Stage Urothelial Carcinoma of the Renal Pelvis or Ureter After Adjuvant Radiotherapy

晚期上泌尿道癌症患者接受術後輔助放射線治療之臨床結果

鄭詠仁(Yung-Jen Cheng) ； 蔡牧宏(Mu-Hung Tsai) ； 郭瑾(Chin Kuo) ； 詹凱翔(Kai-Hsiang Chan) ； 陳海雯(Helen H. W. Chen) ； 薛尉廷(Wei-Ting Hsueh)

《放射治療與腫瘤學》 24卷3期 (2017/09) Pp. 219-228

https://doi.org/10.6316/TRO/201724(3)219

摘要

Purpose : The role of adjuvant radiotherapy after curative surgery to advanced stage urothelial carcinoma (transitional cell carcinoma) of the renal pelvis or ureter has not been proven in large randomized controlled trials. The purpose of this study is to review the outcomes and toxicities of adjuvant radiotherapy for advanced stage upper tract urothelial carcinoma (UTUC) of the renal pelvis or ureter in our single institution. Materials and Methods : We collected the patients with the diagnosis of UTUC of the renal pelvis or ureter, who received nephroureterectomy with bladder cuff resection (NUR+BCR) and adjuvant radiotherapy (RT) in our institution from 2006 to 2015. Clinicopathologic features, treatment modalities, toxicities and outcome variables were retrospectively reviewed. Adjuvant RT was given with intensity modulated radiotherapy (IMRT) technique for all the patients. Systemic chemotherapy (C/T) was administered at the physician’s discretion of medical oncologists. The Kaplan-Meier method was used to estimate overall survival (OS), locoregional recurrence-free survival (LRFS), distant-metastasis-free survival (DMFS) and bladder-recurrence-free survival (BRFS). A subgroup analysis of treatment toxicities and failure pattern between the RT-alone group and C/T-combined group were also performed. Results : Twenty patients were eligible for the final analysis. All the patients received curative surgery and adjuvant radiotherapy with IMRT technique. Median dose of RT was 50.4 Gy (range 45.0 to 64.8 Gy). Median follow-up time was 2.67 years. The estimated 3-year OS, LRFS, DMFS and BRFS were 65.8%, 81.5%, 73.3% and 92.3%. We found that the patients with positive or close surgical margins had inferior overall survival (p= .001). No significant difference could be demonstrated in survival outcome between the groups with or without C/T administration. None of the patients experienced grade 3 or higher acute toxicities in our study. Conclusions : Adjuvant radiotherapy with IMRT technique after curative surgery for advanced stage UTUC patients achieved a comparable outcome with acceptable patient compliance and adverse events in our institution. The benefit of chemotherapy needs further elucidation through novel prospective studies.

關鍵字

Radiation therapy ； Transitional cell carcinoma (TCC) ； Upper tract urothelial carcinoma (UTUC)

並列摘要

目的：輔助放射線治療在術後晚期上泌尿道癌症的角色目前尚未明瞭。本篇回溯性研究目的在於評估一醫學中心的晚期上泌尿道癌症病人接受手術後放射線治療的臨床病理特徵與治療成果。材料與方法：收集自西元 2006 年到 2015 年間，於我們醫院診斷為晚期上泌尿道癌症並接受治癒性手術與輔助放射線治療的病人。本研究採回溯性病歷分析臨床病理特徵、治療、副作用以及治療成果。所有病人接受的放射治療均採用強度調控放射治療（IMRT）。病人接受化療與否則憑臨床醫師判斷。我們使用 Kaplan-Meier 存活分析方法來估計各項存活率，包含了整體存活率（OS）、無局部復發存活率（LRFS）、無遠端轉移存活率（DMFS）以及無膀胱復發存活率（BRFS）。另外分析並比較單獨接受放射線治療或有合併化療的病人，其疾病的復發以及副作用的差別。結果：共 20 位病人納入追蹤分析。所有病人均接受術後輔助放射治療，並採用強度調控的治療技術。治療劑量介於 45.0 至 64.8 Gy，中位數為 50.4 Gy。中位追蹤期間為 2.67 年。所有病人三年的整體存活率、無局部復發存活率、無遠端轉移存活率及無膀胱復發存活率分別為 65.8%、81.5%、73.3%、92.3%。我們發現病人伴隨術後的腫瘤細胞殘留或接近手術組織邊緣（positive or close surgical margin）有較差的整體存活率（p= .001）。次分析單獨接受放射線治療或有合併化療的病人，其疾病的復發及存活分析於統計上沒有顯著的差別。沒有病人紀錄到3級或以上的急性治療副作用。結論：使用輔助性的強度調控放射技術的治療對於晚期上泌尿道癌症並接受治癒性手術的病人，在本醫院的治療成果與其他研究是相當的。且病人的順從度和副作用皆在合理且可接受的範圍內。至於輔助性化療的好處，需要進一步的前瞻性臨床分析才得以闡明。

並列關鍵字

放射治療 ； 移形上皮細胞癌 ； 泌尿上皮癌