膀胱癌に対するCisplatinumとSodiumThiosulfateによる2経路化学療法

Abstract

DDP (100～150 mg/m2)の動脈内投与と同時に, その中和剤であるSTS (20 g/body)を末梢静脈内に投与する2経路化学療法を10例の膀胱癌患者に対して施行した.効果判定は, CR 1例, PR 2例, MR 3例, NC 4例であった.病理組織学的検索をおこなった8例中4例に大星・下里の判定基準によるgrade 2以上の効果が認められた.本療法は, 浸潤性でしかも, hyper-vascularな膀胱癌に比較的有効と考えられた.副作用は, DDPの大量投与の割に軽微で, 肝障害4例, 腎障害1例を認めたがすべて可逆性であった.STSの併用効果はとくに腎障害の軽減化にあるものと思われた

Ten patients with bladder cancer were treated with double channel chemotherapy which included intra-arterial infusion of DDP and concurrent intra-venous infusion of STS, a neutralizing agent against DDP. The method allows the administration of a relatively high dose of DDP to localized malignant tumors by protection from systemic cytotoxicity of DDP by STS. DDP in a dose of 100-150 mg/m2 of body surface was infused either to the internal iliac artery at a portion close to the superior vesical artery or to the aortic bifurcation by the Seldinger technique over 30 minutes, and infusion of 20 g STS to the peripheral vein was simultaneously started and continued for 2-3 hours. One patient achieved a complete response and 2 patients achieved a partial response. The response rate was 30%. Histopathologically, 4 out of 8 patients showed an effect of 2 grades or more by Oboshi-Shimosato's criteria. Invasive or hypervascular tumors seem to be more responsive to the present treatment than superficial or hypovascular ones. Side effects were relatively mild inspite of a large dose of DDP. It should be noted that concurrent STS infusion efficiently counteracts the renal toxicity of DDP.