Etoposide,calboplatin,外照射併用療法の奏功した膀胱原発小細胞癌の1例

Abstract

61歳男.患者は無症候性肉眼的血尿を自覚していたが放置していた.下腹部不快感が出現するに至り, 膀胱鏡検査により浸潤性膀胱腫瘍と診断された.MRI上, 膀胱頂部に筋層浸潤を強く疑う広基性腫瘤を認めた.術前補助療法としてM-VAC療法を1コース終了後, 膀胱全摘術, リンパ節郭清, 回腸導管造設術が施行された.膀胱小細胞癌と診断され, 膀胱周囲脂肪組織への明らかな浸潤を認め, pT3b, pN0, INF-βと診断された.以後, 術後1ヵ月目の造影CTで左肺末梢2ヶ所に小肺転移巣を疑わせる所見を認め, 転移巣は化学療法NGで経過したものの, 再発などは認めずCRと判断した.術後12ヵ月経過現在, 再発は認められていない

A 61-year-old man was referred to our hospital with a complaint of gross hematuria and lower abdominal discomfort. Ultrasonography, magnetic resonance imaging and cystoscopy revealed a nodular invasive tumor in urinary bladder. The histopathological findings of transurethral-biopsy specimen was the small cell carcinoma and transitional cell carcinoma of the bladder infiltrating into smooth muscle layer. Total cystectomy with ileal conduit was performed following 1 course of neoadjuvant chemotherapy (M-VAC). Computed tomography (CT) before adjuvant chemotherapy revealed tiny lung metastasis in left peripheral lung area. As postoperative adjuvant therapy, 4 courses of chemotherapy (etoposide and calboplatin) were performed with 50 Gy of extra beam radiotherapy to the lung metastasis. Follow up CT revealed disapperance of lung metastasis, and the patient has been free from disease for one year after chemotherapy.