尿路上皮癌に対する低用量CDDP併用放射線治療の臨床的検討

Abstract

原発巣が膀胱または尿管の移行上皮癌で, 術後に転移再発をきたした症例あるいは手術適応のない進行性の症例計9例10病変に対して, 増感剤としてCDDP少量連日投与を併用しながら放射線治療を行った.局所に対する奏効率は90%と非常に良好で, 長期生存や根治と思われる症例もあった.進行性の症例には姑息的な目的で施行したが, 疼痛緩和や水腎症改善, 原発巣のコントロールによる出血予防としても効果があった.副作用も重篤なものはなく, 全身状態の改善を認めた症例もあり, 進行性の症例にも有用であると考えられた.しかし, 奏効期間が短く, その後他部位に転移をきたした例が多くみられ, 微小転移を制御する効果は期待できないと考えられた

Chemoradiotherapy using cisplatinum (CDDP) as the X-ray intensifier was performed on patients with urothelial carcinoma. Ten lesions in 9 patients, 6 patients with postoperative relapse and 3 who received the therapy as a palliative treatment for progressive carcinoma, were evaluated. Four of the patients with postoperative relapse had undergone adjuvant chemotherapy. On the day of the treatment, the 9 patients were given continuous intravenous infusion of CDDP at the dose level of 5-12 mg/day prior to external irradiation at 50-66 Gy. The response to the therapy was categorized as complete response in 5 patients, partial response in 4, and no change in 1. The response rate was 90%, indicating achievement of a good local control. Pain relief and improvement of hydronephrosis were also observed in patients who underwent the therapy for treatment of progressive carcinoma. All adverse reactions were mild in intensity. These results suggest that the chemoradiotherapy is useful for both patient groups, those who have a postoperative relapse and those who undergo the therapy as a palliative treatment for progressive carcinoma.