膀胱癌に対するCOMPA動脈内注入療法の経験 : Cis-diammine-dichloroplatinum(2),Vincristine,Methotrexate,Peplomycin,Adriamycin 5者併用

Abstract

1)膀胱癌17例に対し, 亜選択的COMPA動注療法を行い, その近接効果, 副作用, カテーテル・リザーバーの問題点などについて検討した.2)奏効度はCR 4例, PR 10例, NC 3例, 奏効率は82.3%であった.観察期間は5～19ヵ月(平均12ヵ月)であった.3)動注化療後放射線療法を3例に追加したとはいえ, 8例で膀胱を保存しえた.NC 3例を含め7例で膀胱全摘出術を施行したが, 組織学的治療効果は, grade 2:1例, grade 1-a:6例であった.膀胱全摘出術後に実施した2例についても充分な効果がえられた.4)薬剤の副作用は, 食欲不振, 悪心・嘔吐, 脱毛がおもで, 重篤なものはなかった.5)カテーテル, リザーバーの閉塞はなかったが, カテーテル先端の移動, MRSAの感染を1例づつに認めた.リザーバーは動注化療実施中のQOLの向上に役立った

Seventeen patients with bladder cancer were treated with semiselective intraarterial COMPA chemotherapy. One course of COMPA consisted of 20 mg/m2 cis-diammine-dichloroplatinum (CDDP) on days 4 and 5, 0.6 mg/m2 vincristine (VCR) (Oncovin) on days 1 and 2, 5 mg/m2 methotrexate (MTX) on days 2 and 3, 5 mg/body peplomycin (PEP) on days 1, 2 and 3, and 15 mg/m2 adriamycin (ADM) on day 4. These drugs were injected every 2 or 3 weeks through a polyurethane catheter the tip of which was placed just proximal to the aortic bifurcation and during injection both thighs were tied with a pressure of over 250 mmHg. From 2 to 6 courses (mean, 4.4 courses) were administered. Of the 17 patients, 4 achieved complete remission, 10 achieved partial remission and 3 showed no change. After this COMPA chemotherapy eight patients were able to retain their bladders while seven underwent immediate radical cystectomy. The adjuvant COMPA chemotherapy for two patients with pelvic metastasis after radical cystectomy showed good results. Mild degrees of anorexia, nausea, vomiting, hair loss, numbness of fingers and/or toes, leukopenia and intestinal paralysis were observed. Instrumental troubles were seen in two cases; one involved dislocation of the tip of the catheter, the other was infection of the reservoir. Intraarterial COMPA chemotherapy is effective for neoadjuvant therapy of invasive bladder cancer, bladder-preserving treatment and adjuvant therapy of pelvic metastasis.