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摘要: 目的 评价容积调强放射治疗在高龄膀胱癌患者中的安全性和症状缓解率。方法 收集2019年5月—2023年7月于北京大学第一医院放疗科就诊的膀胱癌患者，依据纳入与排除标准，最终46例高龄膀胱癌患者纳入分析，收集这部分患者的一般情况资料，包括年龄、性别、病理类型、TNM分期以及接受的放疗剂量和范围。同时随访收集患者的治疗相关不良反应、症状缓解情况等信息。结果 46例患者中位年龄85(74~94)岁。93.7%的患者病理类型为尿路上皮癌，≥T3的患者占67.4%。全部患者均接受了容积调强放射治疗和每日锥形束CT(cone-beam CT，CBCT)图像引导下的放射治疗。不良反应主要出现在泌尿系统，急性≥3级的泌尿不良反应发生率为6.5%，主要表现为尿痛；晚期≥3级的泌尿不良反应发生率为10.8%，主要表现为血尿、尿痛，其中1例出现了膀胱瘘。无其他≥3级的急性和晚期不良反应。总体的症状缓解率为80.4%，其中，血尿缓解率为94.3%。结论 对于高龄、不耐受手术或化疗的膀胱癌患者而言，采用容积调强放射治疗可以实现肿瘤局部高剂量照射，总体可耐受、近期疗效较好，有可能是年老体弱膀胱癌患者的治疗选择之一。然而，最佳的照射剂量仍需要进一步研究。Abstract: Objective To evaluate the safety and symptoms response rate(SRR) of volumetric modulated arc therapy(VMAT) alone in elderly patients with bladder cancer.Methods Patients with bladder cancer were collected from May 2019 to July 2023 who admitted to the department of radiation oncology in Peking University First Hospital. According to the inclusion and exclusion criteria, 46 patients with bladder cancer were included in the final analysis. The clinical characteristics of the patients were collected, including age, gender, pathological type, TNM stage, radiation dose and volume. The patients were also followed up to collect information on treatment-related side effects and symptoms response.Results The median age of 46 patients was 85 (74-94)years old. The pathologic type of uroepithelial carcinoma was found in 93.7% of the patients, and ≥T3 accounted for 67.4%. All patients received VMAT and daily CBCT image guided radiation therapy. The acute and late side effects were genitourinary(GU) toxicities. The incidence of ≥G3 acute GU toxicity was 6.5%, and urine burning was common. The incidence of ≥G3 late GU toxicity was 10.8% including one vesical fistula, and severe hematuria and painful urination were common. The overall SRR was 80.4%, and hematuria-free rate was 94.3%.Conclusion VMAT may be one of the treatment options which can deliver higher radiation dose to bladder tumor for elderly patients with bladder cancer who do not tolerate surgery or chemotherapy, it was overall tolerable and had good short-term efficacy. However, the optimal irradiation dose still requires further study.
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Key words:
- bladder cancer /
- volumetric modulated arc therapy /
- elderly patients /
- radiation dose
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表 1 研究纳入患者接受的剂量汇总
肿瘤累计物理剂量 肿瘤BED
(α/β：10 Gy)分次剂量、照射次数、持续时间 66 Gy 83.4 Gy 肿瘤局部：66 Gy/25次，全膀胱：45~50 Gy/25次，持续5周 60 Gy 78.0 Gy 肿瘤局部：60 Gy/20次，全膀胱：40~44 Gy/20次，持续4周 55 Gy 70.1 Gy 全膀胱：55 Gy/20次，持续4周 63 Gy 81.9 Gy 第1程肿瘤局部：6 Gy/次，共3次；第2程全膀胱：1.8 Gy/次，共25次，持续5.6周 注：BED为生物等效剂量。 
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表 2 46例患者临床资料汇总
临床资料 例数 比例/% 年龄/岁 74~79 10 21.7 80~85 18 39.1 86~90 16 34.8 >90 2 4.4 性别 男 33 71.7 女 13 28.3 ECOG评分 0 5 10.9 1 40 87.0 2 1 2.1 病理 尿路上皮癌 43 93.7 神经内分泌癌 1 2.1 病理未知 2 4.2 T分期 2 15 32.6 3 26 56.5 4 5 10.9 N分期 阴性 41 89.1 阳性 5 10.9 主要临床表现 血尿 35 76.1 疼痛 6 13.0 其他(尿频、尿急、梗阻等) 5 10.9 放疗剂量 66 Gy/25次 13 28.2 60 Gy/20次 7 15.2 55 Gy/20次 5 10.9 63 Gy/28次 21 45.7 注：ECOG为美国东部肿瘤协作组(Eastern Cooperative Oncology Group)。
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表 3 急性和晚期不良反应汇总
例(%) 不良反应 ≥3级 急性不良反应CTCAE5.0 泌尿 3/46(6.5) 胃肠 0(0) 血液 0(0) 晚期不良反应RTOG标准 泌尿 5/46(10.8) 胃肠 0(0)
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表 4 患者接受放射治疗后的症状缓解情况汇总
主要症状 例数 比例/% 血尿 33/35 94.3 疼痛 3/6 50.0 其他(尿频、尿急、梗阻等) 1/5 20.0 总体 37/46 80.4
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