局所浸潤性膀胱癌に対する動注化学療法 - 長期成績の検討を中心に -

Abstract

局所浸潤性膀胱癌83例に対して, CDDPとADR(又はEPIR)動注化学療法を施行した.1990年6月以降の51例には, 放射線療法を併用した. 1)全体の組織学的CR(pCR)は68%, 動注単独群で41%, 放治併用群は84%. 2)全症例の5年生存率は57%, 動注単独群で44%, 放治併用群は71%. 3)全症例での進達度別5年生存率は, T1+T2;82%, T3a;66%, T3b;28%, T4;25%であり, T1+T2とT3b(p<0.0011), T1+T2とT4(p<0.0001), T3aとT3b(p<0.0263), T3aとT4(p<0.0214), T3bとT4(p<0.029)の各群間に有意差を認めた. 4)全体の46%の症例に膀胱保存を成功させることができた.特に放治併用群においては, 65%の症例に膀胱保存を成功させることができた

A total of 83 patients with locally advanced bladder cancer (T1, n = 5; T2, n = 28; T3a, n = 21; T3b, n = 21; T4, n = 8) were treated with intra-arterial (i.a.) cisplatin and adriamycin (or epirubicin) chemotherapy. In 51 of the 83 cases, we combined this treatment with radiotherapy. The pathological complete response (CR) rate was 68% for all patients, 84% for i.a. chemotherapy combined with radiotherapy and only 41% for i.a. chemotherapy. The 5-year survival rate was 57% for all patients, 71% for i.a. chemotherapy combined with radiotherapy and only 44% for i.a. chemotherapy. The 5-year survival as a function of the clinical stage was 82% for T1 + T2, 66% for T3a, 28% for T3b, 25% for T4 (T1 + T2 vs: T3b: p < 0.001, T1 + T2 vs. T4: p < 0.0001, T3a vs. T3b: p < 0.0263, T3a vs. T4: p < 0.0214, T3b vs. T4: p < 0.029). In 46% of all patients, we succeeded in preserving the bladder; especially noteworthy, is that in 65% of the patients undergoing i.a. chemotherapy combined with radiotherapy, we succeeded in preserving the bladder. These results demonstrate that i.a. chemotherapy combined with radiotherapy is a useful method for locally advanced bladder cancer which may make preservation of the bladder function feasible.