Modified M-VAC療法後に残存腫瘍切除を施行した進行尿路上皮癌患者の治療成績

Abstract

局所浸潤あるいは転移病巣を有する進行尿路上皮癌に対してmodified M-VAC療法(m-M-VAC)を施行後, 残存腫瘍切除術を施行した7例を対象とし, その治療成績について検討した.患者の年齢は49～77歳, 男性6例, 女性1例で, 観察期間は7～61ヵ月であった.m-M-VAC療法は4コース(1例のみ6コース)施行し, complete responseもしくはpartial responseを認めた.副作用にはgrade 3以上の白血球減少と貧血を各4例に, 血小板減少を2例に認め, 全例にgrade 1の悪心, 食欲不振, 脱毛がみられた.7例中5例は現在も生存しており, そのうち, 尿管癌T4N0M0症例は化学療法後61ヵ月, 膀胱癌T3bN2症例は39ヵ月癌なしで生存中である.肺転移2例では, 化学療法後CRとなり術後早期に再発を来たし, 13ヵ月, 29ヵ月で癌死した.進行尿路上皮癌におけるm-M-VAC療法と手術療法の併用は, 適応症例の慎重な選択を要するが, 長期予後を改善させる可能性があり, 治療選択肢のひとつに成り得ると考えられた

We retrospectively evaluated the effect of the surgical resection of the remaining tumor after modified M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) (m-M-VAC) treatment for locally advanced or metastatic urothelial carcinoma. In m-M-VAC therapy, methotrexate and vinblastine on 15 and 22 days were omitted from the classical M-VAC to avoid the discontinuation and the dose reduction, and duration of 1 course was shortened to 21 days from 28 days of the classical M-VAC. Seven patients with locally invasive or metastatic carcinoma of the renal pelvis, ureter, and bladder, 6 males and 1 female, with a median age 64.1 years, ranging from 49 to 77 years received m-M-VAC chemotherapy without severe side effects. In all patients, the residual viable carcinoma was completely resected and they achieved complete remission. The median survival time was 20 months (range, 7 to 61). Five of these 7 patients were still alive. Two patients had no recurrence and achieved long-term survival (survival duration; 61 and 39 months). Although further studies and long-term follow up are required, these results suggest that patients who present with locally advanced or metastatic urothelial carcinoma may benefit from surgical resection after m-M-VAC.