進行セミノーマに対するCarboplatin単剤療法の経験

Abstract

1) Carboplatin療法群の5例中3例がCR, PRの2例に残存腫瘤からの再発を認めたが外科的摘除術とEP療法にて治癒できた。2)副作用についてはVAB6療法で治療した5例と比較した。VAB6群では白血球1, 000/mm3以下を5例中4例に認めたがcarboplatin群では全例2, 000/mm3以上であった(p<0.05)。VAB6群では, 血小板減少, 脱毛, 呼吸障害, 発疹, 耳鳴, 末梢神経障害を認めたがcarboplatin群では1例も認めなかった

Between May 1990 and August 1992, 5 patients with advanced seminoma were treated with single agent carboplatin at Kyoto University. The mean follow-up period of all patients was 23 months. The clinical stage was IIA: 1, IIB: 1, IIIA: 2, IIIB1: 1. Three to 4 courses of carboplatin at 400 mg/m2, were administered intravenously over 1 hour without hydration every 3 to 4 weeks. One patient achieved complete response (CR). Four patients with a residual mass were observed, in two of them the mass disappeared and they remained free of disease. Two of the 4 patients with a residual mass relapsed 11 and 19 months after the start of treatment, and were successfully salvaged with surgery and adjuvant EP (etoposide and cisplatin) therapy. Subsequently, the overall CR rate was 60% and overall survival rate was 100%. The side effects of carboplatin were compared with those of VAB6 (vinblastine, actinomycin-D, bleomycin, cisplatin and cyclophosphamide), with which another 5 patients were previously treated at our hospital. Leukopenia and alopecia were observed in the VAB6 group with a significant difference (p < 0.05). Severe thrombocytopenia, dyspnea, skin rash, tinnitus and numbness were observed in 4 patients in the VAB6 group. However, no other symptoms but nausea and vomiting were observed in the carboplatin group. It was concluded that single agent carboplatin therapy for advanced seminoma was effective and less toxic, and it would be beneficial for the quality of life of patients, but the residual mass should be treated with surgery, cisplatin-based chemotherapy, or radiotherapy because it possibly has a recurrent potential; otherwise it should be carefully observed.