放射線治療作為膀胱泌尿上皮癌患者術後局部復發之成效

張賀翔¹、黃俊杰²、羅浩倫¹、蘇佑立³、方富民²

高雄長庚紀念醫院 泌尿科

Therapeutic Outcome of Radiation Therapy for Postoperative Locoregional Recurrence of Upper Tract Urothelial Carcinoma

Chang Ho Hsiang¹, Chun-Chieh Huang², Yu-Li Su³, Hao-Lun Luo¹, Fu-Min Fang², 

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Taiwan¹

Department of Radiation oncology, Kaohsiung Chang Gung Memorial Hospital, Taiwan²
Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan³
 

Purpose: To assess the therapeutic outcome between salvage and consolidation radiation therapy (RT) for postoperative recurrence of upper tract urothelial carcinoma (UTUC).

Materials and Methods: A total of 30 patients undergoing RT for local or regional recurrence of UTUC from May 2002 to February 2017 were enrolled. Fourteen (46.7%) patients with no response to chemotherapy or without chemotherapy underwent salvage RT and sixteen (53.3%) patients with complete or partial response to chemotherapy underwent consolidation RT. The median follow-up time for survived patients were 5.9 years. Overall survival (OS) since recurrence, locoregional progression-free survival (LRPFS) after RT and distant metastasis-free survival (DMFS) after RT were evaluated. Univariate and multivariate Cox regression analyses were applied.

Results: The median OS since recurrence was 40.0 months, and the 5-year OS, LRPFS and DMFS rates were 46.6%, 45.0% and 36.7%. For patients undergoing salvage RT, the 5-year OS, LRPFS and DMFS rates were 28.6%, 21.4% and 21.4%, respectively; for patients undergoing consolidation RT, those were 63.5%, 65.8% and 50.0%. In univariate analyses, consolidation RT and primary site at ureter were significant prognostic factors for better OS and LRPFS; age ≤ 60.0 years was also a significant factor for OS. In multivariate analyses, consolidation RT, age ≤ 60.0 years and papillary architecture were significant factors for better OS and LRPFS; lymph node dissection was also a significant factor for OS. There was no significant factor for DMFS in univariate or multivariate analyses.

Conclusions: Patients with postoperative local or regional recurrence of UTUC undergoing RT had high 5- year OS and LRPFS rates, especially for the patients undergoing consolidation RT.