The Study Of Neoadjuvant Chemotherapy Combined With Radical Transurethral Photoselective Vaporizationin Treating Muscle-invasive Bladder Cancer

Objective:Bladder cancer is the most common malignant tumor of the urinary system in human beings. Non muscle-invasive bladder cancer(NMIBC) patients are diagnosed at most. Because the tumor cells are more malignant, aggressive, metastatic, recrudescence, complex and morbidity, the muscle-invasive bladder cancer(MIBC) is the main factor of carcinoma mortality. Radical cystectomy(RC) is the standard treatment, but the bigger surgical trauma, more bleeding, higher postoperative complications, and lower quality of life after urinary diversion make the combined treatment of bladder sparing was introduced to MIBC. This study explore the efficacy and safety of neoadjuvant chemotherapy(NAC) combined with radical transurethral photoselective vaporization(RPVBT) in treating muscle-invasive bladder cancer.Method: We retrospective analyzied 42 patients who had MIBC diagnosed from Oct. 2012 to Oct. 2014. They had undergoed RPVBT after 2 or 3 cycles of NAC with gemcitabine/cisplatin. Of which 35 males and 7 females, aged 46 to 82 years, mean 61.4±11.2 years. All patients were confirmed urothelial carcinoma, and clinical stage was T2~T3b by the pelvic MR or CT. Except unsuitable patients, Gemcitabine(800~1000mg/m2) was used on days 1, 8 and 15; cisplatin(70mg/m2) was used ond days 2, hydration was used on days 1 and 2. The course of treatment is 28 days. The effects and adverse reactions of NAC were evaluated before RPVBT. With normal saline, in the first, the tumor body was cutted into large pieces by using the vaporization function of green laser on the base of tumor. Secondly, vaporizaed the tumor from shallow to deep and reached the fat layer outside bladder.The vaporazation range should reach the basal part of the tumor 2cm. Epirubicin 50 mg dissolved in 50 ml saline, sterile catheterization into the bladder, retained for 1 hour. 1 times a week for 8 weeks, then 1 times a month for 10 months. By the end of the follow-up, the effect of chemotherapy, chemotherapy side effects, operative time, blood loss, intraoperative complications, postoperative complications, bladder perfusion response, relapse rate and other indicators were anylazed to evaluate the clinical efficacy and safety of NAC combined with RPVBT in treating MIBC.Result: 42 patients received NAC, During a course of chemotherapy, 1 case stoped treatment beacause of stroke and diverted radical radiotherapy treatment. 41 patients completed a total of 116 cycles of chemotherapy, an average of 2.83 medications. After NAC, the tumor maximum diameters were 1.5~4.5cm(2.28±1.12cm), significantly reduced compared with that before NAC(P<0.05); clinical stage over the previous drop of 26 cases(63.41%); the mumber of tumors was less than it befor NAC of 11 cases(26.83%); 1 patient had pelvic lymph node metastasis, pelvic radiotherapy was treated. 28 cases(68.29%) had varying degrees of drug toxicity, in which the most common bone marrow suppression, reduced neutrophil count 21 cases(51.22%), thrombocytopenia 14 cases(34.15%), anemia in 12 cases(29.27%), only 5 cases(9.76%) with 3 to 4 level toxicity, both neutrophil and platelet counts reduced; loss of appetite, nausea, vomiting and other gastrointestinal reactions 5 cases(12.20%), renal injury in 2 cases(4.88%). 41 cases were successfully completed surgery, operative time 12~75(42.24 ± 13.21) min, bleeding 1~50(22.07±12.22) ml, gross hematuria continued 0~3 days, no bladder perforation, no external fluid bleeding, no postoperative complications. About 12 to 36 months(average 21 months) of follow-up were done.10 cases(27.50%) were recurenced and the first relapse time was 6 to 24 months after RPVBT, 9 cases had got re-RPVBT and postoperative radiotherapy; 1 patient with extensive lymph node metastasis, only treated by palliative radiotherapy and 2 died.Conclusion: NAC(Gemcitabine+cisplatin) can significantly reduce the tumor size, reduce the clinical stage and the patient underwent surgery to retain more conducive bladder; rate of adverse reactions is low, and patient tolerance is easy, NAC is suitable for clinical application. RPVBT has the advantages of less bleed, fewer intraoperative, fewer postoperative complications and the exact effect of removing tumor. The treatment of NAC combined with RPVBT is safe and effective as a method of bladder sparing.