化学療法と放射線療法でCRになった後5年目に再発し膀胱全摘術を行った浸潤性膀胱癌の1例

Abstract

72歳男.表在性膀胱癌へTUR-BtとBCG膀胱内注入を施行してから5年以上再発が見られず, 治癒したと思い来院をしていなかったが, 血尿及び右側腹部痛が出現した.膀胱鏡で右尿管口を覆う乳頭状広基性腫瘍を指摘され, MRIでは壁外浸潤も見られた.TUR-Bt及び動注化学療法と放射線治療を施行し, 腫瘍の完全消失を認めたが, 約5年後に再発を認めた.追加治療の動注化学療法は効果が見られず, 膀胱全摘術を施行した.術後, 再発及び転移徴候は見られなかったが, 熱中症による脱水で衰弱し死亡した

A 72-year-old man had undergone trasucethral resection of bladder tumor (TUR-Bt) three times from 1990 to 1991 and he had been lost to follow with no recurrence from 1996, came to our hospital complaining of asymptomatic macrohematuria in May 1999. A bladder tumor existed around the right ureteral orifice with right hydronephrosis. MRI and TUR-Bt revealed that the cancer was transitional cell carcinoma (TCC) > small cell carcinoma, G3, pT3b. Because the patient insisted on bladder preservation, intra arterial chemotherapy with cisplatinum (CDDP) and epirubicin (EPI-adr) followed by radiotherapy with CDDP was performed. The treatment resulted in a clinical complete response (CR), and the bladder was preserved. In January 2004, an invasive bladder cancer recurred at the left lateral wall. This time, neoadjuvant intra-arterial chemotherapy with CDDP and EPI-adr, followed by radical cystectomy was performed. Histologically, the recurrent bladder cancer was TCC, G3, pT3b.