Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2006 / Cilt: 32 - Sayı: 4
Treatment results of radical cystectony+chemotherapy and transurethral resection+chemotherapy in patients with invasive bladder carcinomas
- Pages
- 453–457
- DOI
- —
Abstract
Introduction: In this study, we reviewed the results of combined therapy with radical cystectomy and adjuvant systemic chemotherapy with complete transurethral resection and adjuvant chemotherapy in patients with muscle invasive bladder transitional cell carcinoma (TCC). Materials and Methods: From October 1999 to August 2004 a total of 22 patients with muscle invasive bladder TCC underwent radical cystectomy+adjuvant chemotherapy (group 1) and 18 patients underwent complete transurethral resection+adjuvant systchemotherapy (group 2). The mean ages were 63.4 (range: 37- 72) years and 71.11 (range: 53-81) years in groups 1 and 2, respectively. The combination of gemcitabine+cisplatin was given every 3 weeks for a total of 4 cycles to the patients as adjuvant chemotherapy. After the treatment, absence of tumor was accepted as “complete response”, while two steps decrease in tumor stage and /or 50 % decrease in tumor volume was accepted as “partial response” and the other findings was accepted as “no response”. Results: The median follow-up was 30.3 (range: 6-48) months and the median survival time was 16.7 (range: 4-48) months in group 1. Pathological findings showed pT2bN1 stage in 4, pT2bN2 in 1, pT3aN1 in 8, pT3aN2 in 2, pT3aN3 in 1, pT3bN1 in 2 and pT4aN1 in 4 cases. During the follow-up, pelvic recurrence was observed in one patient with a pT2bN2 stage and 4 cycles of gemcitabine+cisplatin combination therapy was administered to the patient. Distant metastasis developed in the 10 (%45.5) patients and complete response was achieved in the remaining 11 (50%) patients in group 1. Pathological findings showed stage pT2 G3 tumors in all the patients in group 2. The median follow-up was 20.7 (range: 6-42) months and the median survival time was 343 (range: 6-42) months in this group. Complete response was achieved in 10 (55.6 %) patients, localized recurrence was observed in 5 (27.8%) patients and transurethral resection was performed again to them. Of the 5 patients, 2 had pT1G2 tumoral stage and intravesical BCG was administered to them. Systemic metastasis was observed in the remaining 3 (16.6%) patients. Fifteen (83.3%) patients are disease free alive. Conclusion: Although transurethral resection combined with systemic adjuvant chemotherapy is an alternative treatment in selected patients, radical cystectomy is still the gold standard for patients with invasive bladder TCC.
Özet
Transisyonel hücreli (TCC) invaziv mesane tümörlü hastalara uyguladığımız radikal sistektomi (RS) ve adjuvan sistemik kemoterapi (KT) tedavisi ile komplet transüretral rezeksiyon (TUR) ve adjuvan KT sonuçları gözden geçirildi. Ekim 1999-Ağustos 2004 tarihleri arasında transisyonel hücreli invaziv mesane tümörü nedeniyle RS+adjuvan KT tedavisi yapılan 22 hasta (1. grup) ile komplet TUR+adjuvan KT tedavisi yapılan 18 hastaya (2. grup) ait veriler gözden geçirildi. Hastaların yaş ortalaması 1. grupta 63,4 (37-72), 2. grupta ise 71.11 (53-81) yıl idi. KT protokolünde hastalara 3 hafta arayla toplam 4 kür gemsitabin+sisplatin verildi. Tedavi sonrası tümör saptanmaması tam yanıt; tümör evresinin 2 kademeden fazla düşmesi ve/veya tümör volümünün %50’den fazla azalması kısmi yanıt ve bunun dışındaki bulgularda yanıtsızlık olarak değerlendirildi. 1. grupta ortalama takip süresi 30,3 (6-48) ay, ortalama sağ kalım süresi 16,7(4-48) ay idi. Bu gruptaki 22 hastadan 4’ü pT2bN1, biri pT2bN2, 8’i pT3aN1, 2’si pT3aN2, biri pT3aN3, 2’si pT3bN1, 4’ü pT4aN1 evresinde idi. KT sonrası takipte patolojisi T2bN2 olan 1(%4,5) hastada nüks pelvik kitle tespit edildi ve biyopsinin malin gelmesi üzerine 4 kür daha gemsitabin+sisplatin verildi. 22 hastanın 10 (%45.5) tanesinde uzak organ metastazı gelişti. Geri kalan toplam 11 (%50) hastada ise tam yanıt elde edildi. 2. grupta yer alan hastaların ortalama takip süresi 20.7 (6-42) ay, ortalama sağ kalım süresi ise 34.3 (6-42) ay bulundu. Bu gruptaki hastaların tümünün TUR sonrası patolojisi T2G3 geldi. KT sonrası hastaların 10(%55.6)’unda tam yanıt elde edilirken, 5’inde (%27.8) lokal nüks izlendi ve bu hastalara tekrar TUR yapıldı. Bu 5 olgunun 2’sinde patoloji T1G2 olarak geldi ve bu 2 olgu intrakaviter BCG tedavisi sonrası nüks olmaksızın halen yaşamaktadır. Geri kalan 3 (%16.6) olguda ise sistemik metastaz gelişti. Halen toplam 15 (%83.3) olgu uzak organ metastazı olmadan yaşamaktadır. TUR+adjuvan KT TCC’li invaziv mesane kanser hastalarının seçilmiş alt grupları için bir tedavi seçeneği oluşturmakla beraber radikal sistektomi halen standart tedavi yöntemidir.