To analyze the efficacy of recurrence prophylaxis using radiation and chemotherapy following bladder conservation surgery for muscle invasive bladder cancer Methods 23 patients with muscle invasive bladder cancer were treated with radiotherapy combined with bladder mitomycin infusion after bladder conservation surgery (study group) Radiotherapy was given using an external beam at an average dose of 5148±462 cGy with conventional fractionation For comparison, 29 similar patients treated with postoperative bladder mitomycin infusion without radiation served as control (control group) All patients were followed up for more than 3 years, an average of 41 6 months (36-60 months) Results The 3 year pelvic recurrent rate of muscle invasive bladder cancer was 17 4% in the study group and 44 8% ( P =0 036) in the control group The 3 year distant metastasis rates were 17 4% and 24 1%, respectively ( P =0 554) The 3 year overall survival rates were 81 8% and 86 2%, respectively ( P =0 670) Two patients from the study group had their treatment interrupted, one for 3 days and the other for one week due to acute cystitis, while the rest of the patients were able to complete the treatment according to schedule Conclusion Radiotherapy plus chemotherapy after bladder conservation surgery for muscle invasive bladder cancer can decrease the rate of pelvic recurrence effectively and be used as a realistic adjuvant treatment
目的:观察虎杖对放射性肺损伤大鼠肺组织TGF-β1蛋白、Smad3,Smad4,Smad7mRNA表达的影响,探讨虎杖防治放射性肺损伤的作用机理。方法:随机将180只清洁级雄性SD大鼠分为正常对照组、虎杖预防组、虎杖当天组、虎杖28天组、DXM治疗组,共6组,每组30只,除正常对照组外,其余各组均给予直线加速器全胸单次照射18Gy。虎杖预防组于照射前1周开始灌服虎杖流浸膏,虎杖当天治疗组于造模后第1天开始每日予虎杖流浸膏灌胃,虎杖28天治疗组于造模后第28天开始每日予虎杖流浸膏灌胃,地塞米松治疗组造模后第1天开始每日予地塞米松灌胃用药4周,4周后予1 m L/100 g生理盐水灌胃,正常对照组和模型组予等容积的生理盐水灌胃。每组分别于1、2、3、4、6、8周随机处死4只大鼠,取右肺下叶组织,免疫组化法观察肺组织TGF-β1蛋白表达的变化,RT-PCR法检测肺组织Smad3、Smad4、Smad7mRNA的表达。结果:各组照射后大鼠肺组织均有TGF-β1、Smad3、Smad4不同程度的表达,模型组显著高于正常对照组(P<0.01),各虎杖治疗组与DXM治疗组表达有不同程度下降,与模型组比较有显著差异(P<0.01)。而模型组Smad7的表达显著低于正常对照组(P<0.01)。各虎杖治疗组smad7表达较模型组均有升高,其中虎杖预防组Smad7-mRNA表达在第1周时下降,第2周后表达持续增加,与模型组比较有差异(P<0.05),虎杖当天治疗组在第3周后表达增加,与模型组比较有显著差异(P<0.01)。虎杖预防组与虎杖当天治疗组在第6、8周时表达高于DXM治疗组,有显著差异(P<0.01);虎杖28天治疗组在第6周后Smad7-mRNA表达高于模型组,但与DXM治疗组比较无显著性差异(P>0.05)。结论:虎杖能够降低TGF-β1蛋白的表达,抑制受体激活性蛋白Smad3的表达,下调通用性蛋白Smad4的表达,促进抑制性蛋白Smad7的表达,从而抑制放射性肺损伤大鼠肺脏中TGF-β/Smad信号传导通路的激活,因此虎
