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教材教学课件.ppt

表浅性膀胱肿瘤--卡介苗(BCG)膀胱灌注方案及其与化疗效果的比较 一、表浅性膀胱肿瘤简述二、BCG膀胱灌注治疗方案三、BCG与化疗效果的比较 一、表浅性膀胱肿瘤简述 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。 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 BCG+TUR vs TUR only free of recurrence for a mean follow-up of 33 months: BCG+TUR : 68% TUR only : 41% --from SWOG (Southwest Oncology Group) 二、BCG膀胱灌注 BCG Intravesical therapy Ⅰ. goals Ⅱ. side effects Ⅲ. dosage and administration Ⅳ. treatment schedule Treatment schedule: a single schedule maintenance therapy (6+3) double schedule others “6+3” Regimen : 1.induction period: weekly for 6 weeks 2.maintenance period: 3 weekly at 3, 6, 12, 18, 24, 30, and 36 months 6+3 vs 6+6 : regimen item 6+3 6+6 CR*CIS 87% 63% tumor-free 83% 43%~67% Others: 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