表浅性膀胱肿瘤--卡介苗(BCG)膀胱灌注治疗方案及其与化疗效果的比较课件.pptxVIP

1 2 一、表浅性膀胱肿瘤简述 3 TNN分期: 原发肿瘤(T)分期: Tx:无法对原发肿瘤作出估计。 T0:无原发性肿瘤的证据。 Tis:原位癌。 Ta:非浸润性乳头状癌。 T1:肿瘤侵犯上皮下结缔组织。 T2;肿瘤侵犯浅表肌肉(内半)。 T3a:肿瘤侵犯深部肌肉(外半)。 T3b:肿瘤侵犯膀胱脂肪。 T4:肿瘤已侵犯下列之一:前列腺、子宫、 阴道、盆壁、腹壁。 区域淋巴结(N)分期: Nx:淋巴结有无转移不肯定。 N0:淋巴结无转移。 N1:单个淋巴结转移,最大直径≤2cm。 N2:单个淋巴结转移,最大直径＞2cm、 ≤5cm 。或多个淋巴结转移, 最大直径均≤5cm。 N3:淋巴结转移,最大直径＞5cm。 远处转移(M)分期: Mx:转移范围不肯定。 M0:无远处转移。 M1:有远处转移。 4 定义: 指病灶未侵及膀胱肌层,包括: Ta, CIS, T1 。60%~70% 临床表现: 无痛性血尿,膀胱刺激症 治疗原则: 手术(TUR)为主,化疗、免疫 治疗、生物治疗为辅 5 nfree of recurrence for a mean follow-up of 33 months: BCG+TUR : 68% TUR only : 41% --from SWOG (Southwest Oncology Group) 6 BCG+TUR vs TUR only 二、BCG 膀胱灌注 7 BCG Intravesical therapy Ⅰ. goals Ⅱ. side effects Ⅲ. dosage and administration Ⅳ. treatment schedule 8 neradicating existing disease, ntreat carcinoma in situ nreducing disease recurrence and progression, nimproving patient survival. goals: 9 nCystitis ndysuria nhematuria nBCG infection nfever/chills Side effects: 10 n1x108 ~1x1010 CFU (colony- forming units) n120mgBCG+50ml NS nurethral catheter , converting body position/15mins for 2hs nfollow-up: every 3 months at dosage and administration: 1st year,6 months → 1 year 11 na single schedule nmaintenance therapy (6+3) ndouble schedule others Treatment schedule: 12 1.induction period: weekly for 6 weeks 2.maintenance period: 3 weekly at 3, 6, 12, 18, 24, 30, and 36 months 13 “6+3” Regimen : 6+3 vs regimen item CR*CIS tumor-free 6+6 : 6+3 87% 83% 43%~67% 14 6+6 63% 1.w*6→2w*6→m for 2~3 ys 2.CIS or high-grade: (6+3)→ 3-week at years 4, 5, 6, 8, 10, and 12 15 Others: 三、与化疗效果比较 16 n 噻替哌 n 丝裂霉素C n 阿霉素 n 表阿霉素 常用化疗药物 17 ninstillating time neffect nmechanism nincreasing dose nmaintenance therapy 18 Comparison: 19 nMegadose vitamins nIL-2 nInterferon nintravesical chemotherapeutic drugs: MMC et. nBCG-CWS (卡介苗细胞壁骨架) 20 Combination therapy: Thank you 21