Angiotensin-II combined intra-arterial chemotherapy for locally advanced bladder cancer : a case series study at a single institution

Abstract

臨床病期T2-T4NxM0の膀胱癌を有する患者に, cisplatin, pirarubicin, angiotensin-II(AT-II)を腫瘍栄養動脈より注入し, その治療効果を評価した.その結果, 1)臨床病期T2症例における5年および8年腫瘍特異的生存率は100%, 33%であり, T3-4症例ではそれぞれ63%, 63%であった.両群間に推計学的に有意差は認められなかった(P=0.445). 2)単変量および多変量解析では, 腫瘍数, 増殖型, 腫瘍の大きさが腫瘍特異的生存率と独立して相関傾向があったが, 推計学的有意差は認めなかった.以上, これらのことからも, AT-II併用動脈内注入化学療法は, 重篤な副反応や合併症を伴わず, 比較的良好な治療効果を有し, 局所進行性膀胱癌患者に対する有用な治療法と考えられた

Patients with locally advanced bladder cancer are at significant risk for metastases. We aimed to evaluate the usefulness of intra-arterial chemotherapy (IAC) combined with angiotensin-II (AT-II) in such patients. The possibility of bladder preservation is also discussed. Patients were enrolled if they had muscle-invasive bladder cancer (stage T2 to T4NxM0). Cisplatin, pirarubicin, and AT-II were infused through the tumor-feeding arteries. Cause-specific survival was the end point. We enrolled 37 patients who were treated with neoadjuvant IAC and 5 patients with adjuvant IAC. There were 7 patients (16.7%) with pathological complete remission. Overall 5-year and 10-year survival rates of the patients were 61.3% and 47.7%, respectively. The 5-year cause-specific survival rate was 100% for the clinical T2 group and 63% for the T3-4 group, and the 8-year survival rate was 33% and 63%, respectively. There was no statistically significant difference between these two groups (P=0.445). Multivariable analysis using tumor number, pattern of growth, and tumor size seemed to independently correlate with cause-specific survival, but there were no significant differences. Our results suggest that intra-arterial chemotherapy combined with AT-II is a useful treatment for patients with locally advanced bladder cancer, since this modality achieves a favorable response rate without severe toxicity or mortality.