膀胱癌に対する動注化学療法の工夫 リザーバー動注を中心に, QOL, 治療効率を考慮した動注方法の模索

Abstract

浸潤性膀胱癌56例に対してリザーバー動注化学療法を施行した.内46例に骨盤内血流改変術を併用した. 1)46例中42例, 91%に良好な血流改変が行われていた. 2)腫瘍に対する近接効果は評価を行えた50例中CR23例, PR17例, NC6例, PD4例で奏効率80%であった. 3)追跡可能であった54例の累積生存率は1年83.7%, 3年61.2%, 5年52.6%, 8年52.6%. 4)CR例23例中検討可能であった22例におけるCR判定後の無再発率は1年91.8%, 2年85.2%, 3年65.6%, 5年58.3%, 7年58.3%. 5)合併症として留置カテーテル閉塞6例, カテーテル・ポート部感染3例, 副作用として軽度の消化器症状5例, 軽度の下肢痛2例, 骨髄抑制の疑い1例を認めた

Fifty-six patients with locally invasive bladder cancer were treated by chemotherapy with intermittent arterial infusion from an implanted reservoir and alteration of intrapelvic blood flow. The tip of an infusion catheter was inserted selectively into an internal iliac artery by an angiographic technique. Superior gluteal artery and the other internal iliac artery were then embolized with steel coils so that the drugs would perfuse throughout the tumor through a single catheter. Treatment consisted of intermittent injection of cisplatin (10 mg/body) and doxorubicin (10 mg/body) or epirubicin (10 mg/body) or pirarubicin (10 mg/body) in a ten-minute period every week (for the first 8 weeks) or every two weeks (after the 8th week). Fifty patients were objectively evaluated and the response rate was 80%. The overall survival rate in 54 patients at 1, 3, 5 and 8 years was 83.7%, 61.2%, 52.6%, and 52.6%. The 1-, 2-, 3-, 5- and 7-year disease free survival rate in evaluable 22 patients who showed a complete response (CR) was 91.8%, 85.2%, 65.6%, 58.3% and 58.3%. No serious side effects, such as severe myelosuppression or renal and/or liver dysfunction, were noted during treatment. These findings suggest that intermittent arterial chemotherapy with an implanted reservoir is clinically useful. This procedure appears safe and is easily performed in the outpatient clinic for the treatment of locally advanced bladder cancer.