局所浸潤膀胱癌に対するMEC療法(Methotrexate, Epirubicin, Cisplatin)によるNeoadjuvant療法の検討

Abstract

局所浸潤膀胱癌患者18人に対してMEC療法をネオアジュバント療法として施行した.術前の臨床病期と比べpathological stageがdownしていた症例は12例であり奏効率67%であった.奏効例は非奏効例と比較して有意に予後良好であった.副作用は血小板減少がやや強い傾向を認めたが比較的安全に投与可能であった.以上のことより, MEC療法はネオアジュバント療法として有用であると考えられた

Eighteen patients with locally invasive bladder cancer were treated with 1 or 2 cycles of neoadjuvant chemotherapy consisting of methotrexate, epirubicin and cisplatin (MEC). All patients underwent radical cystectomy and pelvic lymph node dissection. Down-staging was observed in twelve (complete pathological response in 3 and partial pathological response in 9) patients (response rate were 67%). Four of the 18 patients died of disease and all of them had not achieved down-staging. Multivariate analysis revealed nodal status to be the only independent predictor. With regard to side effects, gastrointestinal symptoms and myelo-suppression were observed in almost all patients. Thrombocytopenia was observed in 13 patients (72%) including 7 patients who showed symptoms over grade 3. Gastro-intestinal symptoms and leukocytopenia disappeared with granisetron and granulocyte colony stimulating factor. There were no treatment-related deaths in this study. These results indicate that MEC therapy was safely performed and showed a high response rate in patients with locally invasive bladder cancer.