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首页> 外文期刊>BMC Urology >Transperineal cryotherapy for unresectable muscle invasive bladder cancer: preliminary experience with 7 male patients
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Transperineal cryotherapy for unresectable muscle invasive bladder cancer: preliminary experience with 7 male patients

机译：经会阴冷冻疗法治疗无法切除的肌肉浸润性膀胱癌：7名男性患者的初步经验

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Background Radical cystectomy (RC) with pelvic lymph node dissection (PLND) and urinary diversion (UD) is considered the standard treatment for muscle invasive bladder cancer (MIBC). In a part of patients, RC procedure is aborted?due to unresectable disease, other followed treatment like systemic chemotherapy, radiotherapy or cryotherapy may be a better option. The aim of present study was to report the preliminary results of transperineal cryotherapy for unresectable muscle invasive bladder cancer. Methods From January 2011 to August 2013, 7 male patients with pT4b unresectable bladder cancer underwent bilateral ureterocutaneostomy. Two performed a pelvic lymph node dissection (PLND). Then primary transperineal cryosurgery for preserved bladder at the guidance of transrectal ultrasound (TRUS) was performed. All patients underwent a dual freeze-thaw cycle using third-generation cryotechnology with ultrathin 17-gauge cryoneedles. Computer tomography (CT) and/or magnetic resonance image (MRI)were performed at 3?month intervals after cryosurgery to determine whether progression or recurrence occurred. Results All cryosurgery was performed successfully, mean operation time was 76.43?±?25.12?min (range 50-120?min), mean blood loss was 19.29?±?15.92?ml (range 5-50?ml). Mean hospital stay was 3.86?±?1.68?day (range 2-7?days). No operative related deaths occurred. Four patients dead due to the metastasis disease at the follow up time of 8, 15, 18 and 37?months, respectively. Six patients received postoperative therapy, of whom 5 patients were treated with combined chemoradiation, and the other one received chemotherapy alone. The progression free survival (PFS) of the 7 patients was 22.00?±?14.61?months (range 3-40?months). The one, two and three year overall survival (OS) was 85.7%, 57.1% and 42.9%, respectively. Conclusion Our results suggest that cryosurgery combination with chemoradiotherapy provide a safe and effective alternative method for unresectable pT4b bladder cancer. Longer follow-up is necessary to determine the sustained efficacy.
机译：背景技术盆腔淋巴结清扫术（PLND）和尿路改道（UD）的根治性膀胱切除术（RC）被认为是肌肉浸润性膀胱癌（MIBC）的标准治疗方法。在部分患者中，由于无法切除的疾病而导致了RC手术中止，其他后续治疗，例如全身化学疗法，放疗或冷冻疗法可能是更好的选择。本研究的目的是报告经会阴冷冻疗法治疗无法切除的肌肉浸润性膀胱癌的初步结果。方法2011年1月至2013年8月，对7例pT4b不可切除的男性膀胱癌患者进行了双侧输尿管切开吻合术。其中两个进行了盆腔淋巴结清扫术（PLND）。然后在经直肠超声（TRUS）的指导下进行经会阴部保留膀胱的初次冷冻手术。所有患者均使用第三代冷冻技术和超薄17规格的冷冻针进行了双重冻融循环。冷冻手术后每隔3个月进行一次计算机断层扫描（CT）和/或磁共振图像（MRI），以确定是否发生了进展或复发。结果所有冷冻手术均成功完成，平均手术时间为76.43±25.12分钟（50-120分钟），平均失血为19.29±15.92毫升（5-50毫升）。平均住院天数为3.86±1.68天（范围2-7天）。没有发生与手术相关的死亡。分别在8、15、18和37个月的随访时间死于转移性疾病的4名患者。 6例患者接受了术后治疗，其中5例接受了联合化学放疗，另一例仅接受了化疗。 7名患者的无进展生存期（PFS）为22.00±±14.61？个月（3-40个月）。一年，两年和三年的总生存率分别为85.7％，57.1％和42.9％。结论我们的结果表明，冷冻手术联合放化疗可为无法切除的pT4b膀胱癌提供一种安全有效的替代方法。需要更长的随访以确定持续的疗效。

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