The Study Of Treatment Of MIBC By Neoadjuvant Radiotherapy,RPVBT And Adjuvant Chemotherapy

Objective: To compare the clinical efficacy of neoadjuvant radiotherapy combined with radical greenlight vaporization and adjuvant chemotherapy and radical cystectomy for muscul invasive bladder cancer,and to evaluate the postoperative quality of life of patients with functional assessment of cancer therapy-bladder.By analyzing postoperative survival and quality of life,to explore a new methods for MIBC patients to retain the bladder treatment.Method:The clinical data of 207 patients with muscle invasive bladder cancer admitted from Tianjin People’s Hospital from March 2008 to March 2012 were collected.Screening imaging and cystoscopy biopsy were T2 ~ T3 a and met the standard of MIBC 143 patients were divided into RPVBT group and traditional radical group according to the treatment regimen.Among them,RPVBT group was included in 87 patients,and 56 cases were included in the traditional radical group.RPVBT group received preoperative neoadjuvant radiotherapy(IMRT,44 ~ 50 Gy /25 ~ 30 times / 5 ~ 6 weeks),and according to the degree of patient tolerance,4 to 6weeks after the end of radiotherapy RPVBT surgery,Postoperative patients with 4 to6 cycles of gemcitabine combined with cisplatin adjuvant chemotherapy.Traditional radical treatment group MIBC patients were routine cystectomy plus lymph node dissection,postoperative pathology p T3 a with lymph node metastasis were given GC chemotherapy.The information on the complications,survival and recurrence of the two groups of patients was collected and the quality of life was evaluated.The survival rate,tumor recurrence rate,complication and quality of life were compared between the two groups,and the difference of the curative effect between the two treatments was discussed.Result: Some of the patients received neoadjuvant radiotherapy with tumor volume was significantly reduced or even disappeared,the effective rate was 77.0%(67/87);neoadjuvant radiotherapy for gastrointestinal interference is small,the main complications For radioactive cystitis.The incidence of postoperative complications was significantly lower in the RPVBT group(16.1%)than in the conventional surgery group(44.6%).The survival rate of RPVBT group was 96.6%,88.5%,70.1%,57.5% and 44.8% respectively after 1,2,3,4 and 5 years survival in the traditional traditional radical control group(92.9%,85.7%,69.6%,67.9%,66.1%,respectively).The statistical analysis showed that there was no significant difference in survival rate between RPVBT group and traditional radical group(P = 0.665).The FACT-BL scores of all muscle invasive bladder cancer patients were gradually increased at 3,6,12,24,36,48 and 60 months after operation,and the health-related post-operative quality of RPVBT group Quality of life,Functional Assessment of Cancer Therapy-Bladder,FACT-BL were significantly higher than those in the traditional radical group(P = 0.01).Conclusion: Compared with radical resection of bladder cancer,neoadjuvant radiotherapy combined with RPVBT and postoperative adjuvant chemotherapy,the incidence of serious complications is low,and the overall survival rate was no significant difference,and the quality of life of patients was significantly higher than the traditional radical surgery.It can be seen that neoadjuvant radiotherapy combined with RPVBT and postoperative GC adjuvant chemotherapy is a new treatment modality for patients with bladder transitional cancer with T2 ~ T3 a.