Thesis (Ph.D)-Cairo University-National Cancer Institute-Department Of Surgical oncology-2023.

Bibliography: pages 95-122.

ﯾﻌﺪ ﺳﺮطﺎن اﻟﻤﺜﺎﻧﺔ ورﻣﺎ ﺧﺒﯿﺜًﺎ ﻋﺪواﻧﯿًﺎ وھﻮ أﺣﺪ أﻛﺜﺮ ﻋﺸﺮة أﻧﻮاع ﻣﻦ اﻟﺴﺮطﺎﻧﺎت ﺷﯿﻮﻋﺎ. ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن اﻟﮭﺪف اﻷﺳﺎﺳﻲ ﻟـﻼﺳﺘﺄﺻﺎل اﻟﺠﺬري ﻟﺴﺮطﺎن اﻟﻤﺜﺎﻧﺔ ھﻮ إزاﻟﺔ اﻟﻮرم اﻟﺮﺋﯿﺴﻲ وإﺟﺮاء اﻟﺘﻔﺮﯾﻎ اﻟﻤﻨﺎﺳﺐ ﻟﻠﻐﺪداﻟﻠﻤﻔﺎوﯾة ﺑﺎﻟﺤﻮض ، ﻓﺈن ﻧﺘﺎﺋﺞ اﻟﺠﺮاﺣﺔ ﻛﻌﻼج ﻣﻨﻔﺮد أﻗﻞ ﻣﻦ اﻟﻌﻼج ﻣﺘﻌﺪد اﻟﻮﺳﺎﺋﻂ ﻣﻊ إﺟﻤﺎﻟﻲ ﻣﻌﺪﻻت اﻟﻤﻀﺎﻋﻔﺎت ﻋﺎﻟﯿﺔ اﻟﺪرﺟﺔ ﺗﺼﻞ40٪ اﻟﻰ 60٪ ﻓﻲ ﺑﻌﺾ اﻟﺪراﺳﺎت. ﻋﻼوة ﻋﻠﻰ ذﻟﻚ ، ﻣﻌﺪل اﻟﻮﻓﯿﺎت ﯾﺼﻞ إﻟﻰ 7-3٪ ﺧﻼل 90 ﯾﻮﻣﺎ. ادت اﻟﺠﮭﻮد اﻟﺤﺜﯿﺜة ﻓﻲ ﺗﻘﻠﯿﻞ اﻟﻤﻀﺎﻋﻔﺎت واﻟﻮﻓﯿﺎت ﻣﻊ اﻟﺤﻔﺎظ ﻋﻠﻰ اﻟﻤﺜﺎﻧة اﻟﻰ ﻋﻤﻞ اﻟﻌﻼج ﺛﻼﺛﻲ اﻻذرع واﻟﺬي ﯾﻌﻄﻲ ﻧﺘﺎﺋﺞ ﻣﻘﺎرﺑة ﻟﻼﺳﺘﺌﺼﺎل اﻟﺠﺬري ﻣﻊ رﻓﻊ ﻣﺴﺘﻮى ﺟﻮده اﻟﻌﻼج ورﺿﻰ اﻟﻤﺮﺿﻰ. ﻓﻲ ھﺬه اﻟﺪراﺳﺔ ﺗﻢ ﺗﻘﺴﯿﻢ 225 ﻣﺮﯾﻀﺎ إﻟﻰ ذراﻋﯿﻦ 110) ﻣﺮﯾﻀﺎ ﻓﻲ ﻣﺠﻤﻮﻋﺔ اﻻﺳﺘﺌﺼﺎل اﻟﺠﺬري و 115 ﺟﯿ ًﺪا اﻟﻌﻼج ﺛﻼﻟﺜﻲ اﻻذرع.( ﻛﺎﻧﺖ اﻟﺨﺼﺎﺋﺺ اﻷﺳﺎﺳﯿﺔ ﻟﻠﻤﺮﺿﻰ واﻷورام ﻣﺘﻮاﻓﻘﺔ ﻣﺮﯾﻀﺎ ﻓﻲ ﻣﺠﻤﻮﻋﺔ ﺑﻘﺪر اﻟﻤﺴﺘﻄﺎع. ﺗﻢ إﺟﺮاء ذراع اﻻﺳﺘﺌﺼﺎل اﻟﺠﺬري ﺑﻮاﺳﻄﺔ ﺟﺮاﺣﯿﻦ ﺧﺒﺮاء ، ﻛﻤﺎ ﺗﻢ اﺟﺮاء اﻻﺳﺘﺌﺼﺎل ﺑﻮاﺳﻄﺔ ﻧﻔﺲ اﻟﻔﺮﯾﻖ طﻮال ﻓﺘﺮة اﻟﻜﺎﻣﻞ ﻟﻠﻮرم ﻋﻦ طﺮﯾﻖ ﻣﻨﻈﺎر اﻟﻤﺜﺎﻧة ﻓﻲ ﻣﺠﻤﻮﻋة اﻟﻌﻼج ﺛﻼﺛﻲ اﻻذرع اﻟﺪراﺳﺔ. ﻛﺎن اﻟﻌﻤﺮ واﻟﺠﻨﺲ وﻣﺮﺣﻠﺔ اﻟﻮرم ﻣﺘﻮاﻓﻘﯿﻦ ﺑﯿﻦ اﻟﻤﺠﻤﻮﻋﺘﯿﻦ ﺑﯿﻨﻤﺎ ﻣﺜﻠﺖ اﻷورام أﺣﺎدﯾﺔ اﻟﺒﺆرة اﻟﻨﺴﺐ اﻻﻋﻠﻰ ﻓﻲ ﻣﺠﻤﻮﻋة اﻟﻌﻼج ﺛﻼﻟﺜﻲ اﻻذرع وھﺬا ﺗﺤﯿﺰ اﺿﻄﺮﯾﻨﺎ اﻟﻌﻤﻞ اﻻﺳﺘﺌﺼﺎل اﻟﻜﺎﻣﻞ ﺑﺎﻟﻤﻨﻈﺎر. ﻛﺎﻧﺖ اﻻﺳﺘﺠﺎﺑﺔ اﻟﺴﺮﯾﺮﯾﺔ اﻟﻜﺎﻣﻠﺔ ﺑﻌﺪ اﻟﻌﻼج ﺛﻼﺛﻲ اﻻذرع ﯾﻤﺜﻞ ﻧﺴﺒة%80 وھﺬا ﻣﻘﺎرب ﻟﻨﺘﺎﺋﺞ اﻻﺑﺤﺎث ﻣﻘﺎرﻧة ﺑﻤﺠﻤﻮﻋة اﻻﺳﺘﺌﺼﺎل اﻻﺧﺮى اﻟﺘﻲ اﺟﺮﯾﺖ ﻋﻠﻰ ﻧﻔﺲ طﺮﯾﻘة اﻟﻌﻼج. ﻛﺎﻧﺖ ﻧﺘﺎﺋﺞ اﻻرﺗﺠﺎع اﻟﻤﻮﺿﻌﻲ اﻋﻠﻰ ﻓﻲ ﻣﺠﻤﻮﻋة اﻟﻌﻼج ﺛﻼﺛﻲ اﻻذرع اﻟﺠﺬري واﻟﺬي ﻋﻮﻟﺞ ﺑﺎﻻﺳﺘﺎﺻﺎل اﻟﺠﺬري. ﺗُﻈﮭﺮ ﻧﺘﺎﺋﺠﻨﺎ ﻟﺘﺤﻠﯿﻞ اﻟﺒﻘﺎء اﻟﻜﻠﻲ أن ﻣﺘﻮﺳﻂ اﻟﺒﻘﺎء ﻋﻠﻰ اﻟﺤﯿﺎه ﻛﺎن اﻋﻠﻰ ﺑﺼﻮره ﻣﻠﺤﻮظة ﻓﻲ ﻣﺠﻤﻮﻋة اﻟﻌﻼج ﺛﻼﺛﻲ اﻻذرع ﻣﻘﺎرﻧة ﺑﺎﻻﺳﺘﺌﺼﺎل اﻟﺠﺬري وان اﻟﺒﻘﺎء ﺑﺪون اورام ﻟﻢ ﯾﺨﺘﻠﻒ ﻛﺜﯿﺮا ﺑﯿﻦ اﻟﻤﺠﻤﻮﻋﺘﯿﻦ. ﻣﻘﺎرﻧﺔ اﻻﺳﺘﺌﺼﺎل اﻟﺠﺬري ﻛﺎﻧﺖ اﻹﻗﺎﻣﺔ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ أﻋﻠﻰ ﺑﺸﻜﻞ ﻣﻠﺤﻮظ ﻓﻲ ﻣﺠﻤﻮﻋﺔ ﻓﻲ دراﺳﺘﻨﺎ ﺑﻤﺠﻤﻮﻋﺔ اﻟﻌﻼج اﻟﺘﺤﻔﻈﻲ ﺛﻼﺛﻲ اﻻذرع . ﻣﻤﺎ أﺛﺮ ﻋﻠﻰ اﻟﺤﺎﻟﺔ اﻟﻤﺎﻟﯿﺔ ﻟﻠﻤﺮﺿﻰ وﺻﺤﺘﮭﻢ اﻟﻨﻔﺴﯿﺔ ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ ﺗﻌﺮﺿﮭﻢ ﻟﻌﺪوى اﻟﻤﺴﺘﺸﻔﯿﺎت. وﻋﻨﺪ ﻣﻘﺎرﻧة اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﺗﻢ ﻋﻤﻞ ﻟﮭﻢ اﺳﺘﺌﺼﺎل ﺟﺬري ﻟﻠﻤﺜﺎﻧة ﺑﻌﺪ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ واﻻﺷﻌﺎﻋﻲ وﻣﺮﺿﻰ ﺗﻤﺖ ﻟﮭﻢ اﻟﻌﻤﻠﯿة ﺑﺪون ان ﯾﺴﺒﻘﮭﺎ ﻋﻼج اﺷﻌﺎﻋﻲ وﻛﻤﯿﺎﺋﻲ وﺟﺪ ان اﻟﻤﻀﺎﻋﻔﺎت ﻣﺜﻞ ﺗﺴﺮب اﻟﺒﻮل او اﻟﺒﺮاز او اﻟﺘﮭﺎب اﻟﺠﺮح وﻏﯿﺮھﺎ ﻻ ﯾﺨﺘﻠﻒ ﻛﺜﯿﺮا ﺑﯿﻦ اﻟﻤﺠﻤﻮﻋﺘﯿﻦ. ﻟﻘﺪ ﺗﻮﺻﻠﻨﺎ إﻟﻰ أن اﻟﻌﻼج اﻟﺘﺤﻔﻈﻲ ﺛﻼﺛﻲ اﻻذرع ﻋﻼج ﻣﺘﺎح وﺳﮭﻞ اﻟﺤﺼﻮل ﻋﻠﯿه وﻋﻨﺪ ﻧﺠﺎﺣه ﯾﺆدي اﻟﻲ ﻧﺘﺎﺋﺞ ﻣﺮﺿﯿه ﺟﺪا ﻟﻠﻤﺮﺿﻰ ﻣﻊ ﻣﻀﺎﻋﻔﺎت ووﻓﯿﺎت اﻗﻞ ﻣﻦ اﻟﻌﻼج اﻟﺠﺬري ﻟﻠﻤﺜﺎنه وھﺬا اﻟﻌﻼج اﻟﺘﺤﻔﻈﻲ ﯾﺤﺘﺎج اﻟﻲ اﺧﺘﯿﺎر دﻗﯿﻖ ﻟﻠﻤﺮﺿﻰ وﻣﺘﺎﺑﻌﺘﮭﻢ ﺟﯿﺪا ﺑﻌﺪ اﻟﻌﻼج ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﻧﻔﺲ ﻧﺘﺎﺋﺞ اﻻﺳﺘﺌﺼﺎل اﻟﺠﺬري ﻣﻦ ﺟﯿﺚ اﻟﺴﯿﻄﺮه ﻋﻠﻰ اﻟﻮرم .

In the last decade, organ-preserving therapies have been developed as an alternative to radical therapy for organ-localized malignancies with the aim of minimizing toxicity and improving the quality of life, while maintaining similar oncologic outcomes. There is no ideal substitute for the urinary bladder and there is no ideal urinary diversion, even nerve sparing orthotopic continent diversion has the defects of metabolic derangements, night incontinence and probably ureteric strictures in addition to renal back pressure and recurrent urinary tract infections leading to renal impairment or even renal failure with transient or permanent degree of potency affection. Trimodal therapy (TMT) is probably the most effective bladder-sparing treatment, limiting salvage radical cystectomy to non-responders or local invasive disease recurrences. In TMT the patient with muscle invasive bladder cancer (MIBC) meeting the criteria of preservation will undergo maximum visual trans-urethral resection of the bladder lesion (TURT) followed by concurrent chemoradiation (CCRth) and follow up as indicated.
Methods: Patients who were diagnosed to have MIBC between July 2019 and May 2020 and considered to be candidates for surgery and meeting the enrollment criteria were included in this prospective, single center, controlled pilot feasibility trial and scheduled to undergo RC (with neoadjuvant chemotherapy) or organ sparing trimodal treatment.
Results:. 225 patients were allocated into two groups (110 patients in RC group and 115 in TMT group). All patients were followed-up and analyzed statistically The overall survival analysis showed that the mean survival time was significantly delayed with a lower HR (95%CI) of 0.405 (0.2 to 0.82) in patients treated with TMT as compared to those subjected to RC [HR (95%CI): 2.47 (1.22 to 5.003)] a comparable mean disease-free survival time between patients treated with TMT and those subjected to RC with similar hazard ratios.

Issues also as CD.

Text in English and abstract in Arabic & English.