局所浸潤性膀胱癌に対する阻血動注化学療法 - 膀胱温存のための正確なStaging -

Abstract

1)術前BOAIにより, 浸潤性腫瘍(T2以上)の27.0%にTUR-Btが施行され, 膀胱を温存することが可能となった.その長期成績を検討すると, 膀胱を温存しても予後は良好であり, 術前動注療法は, minimum invasive surgeryを可能にする. 2)膀胱温存のためには正確な腫瘍の深達度診断が必要である.経直腸MRIは従来の画像診断法と比べて, 深達度診断の正診率を向上させることが可能

The possibility of bladder preservation by preoperative balloon occluded arterial infusion (BOAI) chemotherapy was studied in 111 patients with locally invasive bladder cancer. BOAI was performed by blocking the blood flow of the internal iliac artery and by performing intra-arterial infusion of adriamycin (50 mg/body) and cisplatin (100 mg/body). Before BOAI the clinical diagnosis was T2 in 36, T3a in 29, T3b in 27, T4 in 11 and after BOAI it was T0 in 1, T1 in 27, T2 in 25, T3a in 20, T3b in 20, and T4 in 10. Down staging was observed on diagnostic images in 46.6%. Thirty patients (27.0%) received transurethral resection of bladder tumor (TUR-Bt) and their bladder could be preserved. The 5-year cancer-specific survival rate was 100% in pT0 (n = 9), 97.5% in pT1 (n = 47), 79.9% in pT2 (n = 21), 80.0% in pT3a (n = 6), 39.9% in pT3b (n = 18) and 51.9% in pT4 cases (n = 9). For the bladder preservation, accurate staging diagnosis is required. Since 1992, endorectal magnetic resonance imaging (MRI) has been used in addition to imaging diagnosis for improving the accuracy of staging diagnosis. The accuracies of staging diagnosis with and without endorectal MRI were 62.5% and 44.0%, respectively. BOAI as a neoadjuvant chemotherapy has the possibility of bladder-preserving therapy in locally invasive bladder cancer. Also, the endorectal MRI can improve the accuracy of staging diagnosis, which is important for the bladder preservation.