Small cell bladder cancer: should we consider prophylactic cranial irradiation?

ABSTRACT Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence. Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival. Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 – 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 - year survival. Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

摘要 目的：描述本机构收治的膀胱小细胞癌患者的临床特征、治疗模式与转归，其中包括接受预防性颅脑照射（prophylactic cranial irradiation，PCI）以预防颅内复发的患者。材料与方法：回顾性分析1990年1月至2015年8月期间单中心收治的膀胱小细胞癌患者的人口学特征、肿瘤分期、治疗方案及总生存期。结果：共纳入44例确诊膀胱小细胞癌的患者，其中11例（25%）在初诊时即存在转移性疾病。治疗方案包括全身化疗（70%）、根治性手术（59%）及局部放疗（39%），另有6例（14%）患者接受了预防性颅脑照射。患者的中位总生存期为10个月（四分位间距4~41个月）。广泛期患者的总生存期劣于器官局限性疾病患者（分别为8个月与36个月，P=0.04）。在接受预防性颅脑照射的患者中，33%实现了5年生存。结论：膀胱小细胞癌患者的预后仍较差，亟需开展进一步研究以明确预防性颅脑照射是否可提升膀胱小细胞癌患者的总生存期，尤其是对化疗应答的广泛期患者。