膀胱癌的放射線合併治療

Radiotherapy in the Combined Treatment of Bladder Cancer

洪志宏(Ji-Hong Hong) ； 陳明憲(Min-Shen Chen) ； 林芳仁(Fang-Je Lin) ； 粱爲民(Wai-Man Leung)

《中華放射線醫學雜誌》 13卷1期 (1988/03) Pp. 39-44

摘要

長庚醫院放射治療科於民國69年11月至73年10月，對81位接受全膀胱切除的病人採合併手術與放射治療。第一群病人隨位為病理Stage B2以上的病人做手術後40至50Gy照射。第二群69位病人接受手術前16-20Gy 4-5fx照射，並於手術後病理Stage B2以上倣16至24Gy追加治療。五年存活率為Stage A&B1: 65%, Stage B2: 44%, Stage C: 28%, Stage D1: 0%。在25位可確知復發病人中13位(52%)局部復發。21位(84%)有遠側轉移。併發症以第一群病人最高，手術後追加劑量次之，只做手術前照射最低。全部併發症所佔比例依次為50%, 38%, 21%，嚴重併發症為25%, 17%, 3%。雖未達統計學上有意義，但仍可看出此趨勢，所以應避免使用手術後大劑量照射。至於第二群病人是否必要冒較大副作用的危險對於stage B2以上病人做手術後追加劑量，則有待進一步前瞻陸分組研究來証實。另外由Stage D1無存活病人以及復發病人中84%有遠側轉移顯示需要發展其他有效的輔助治療如化學治療），以增加局部及遠側轉移控制率。

關鍵字

膀胱癌 ； 手術前放射線治療 ； 手術後加強照射

並列摘要

From November 1980 through October 1984, eighty-one bladder cancer patients were treted at Radiationoncology Department, Chang Gung Memorial Hospital. Twelve of themreceived cystectomy, first, then radiation therapy of 40-50 Gy for the pelvis (Group I). All of these 12 patients were stage B2 or had more advanced disease. Sixty-nine patients (Group II) had radiationtherapy of 1620 Gy prior to surgery, after the operation, an additional post-operative radiotherapy of 16-24 Gy was given for those of B2 or above stages. The five year survival rates were: 65% for stage A and B1, 44% for stage B2, 28% for stage C and 0% for stage D1. Twenty-five patients were confirmed having recurrence; among them, thirteen (52%) had local recurrence and twenty-one (84%) had distant metastasis. Total complication rate (major and minor) was high in Group I, 50%; intermediate for those received post-operative radiotherapy in Group II, 38%; and was lowest for thgose did not receive post-operative radiotherapy, 21%. The major complication rates whereas were 25%, 17% & 3% respectively. Although they showed no statistic significance (P≧0.05), there was a trend for complication occurance in those who had post-operative radiotherapy, especially when the post-operative radiotherapy dose was high. Therefore should the B2 and more advanced stages patients receive a post-operative radiotherapy in the risk of more complications needed a further randomized study. The grave result in stage D1, and high metastatic rate in the recurrent cases (84%) indicated the necessity for adjuvant therapies for a better local control and reduce the metastatic rate.

並列關鍵字

bladder cancer ； preoperative radiation therapy ； postoperative boost