表在性膀胱腫瘍に対するBCG膀胱内注入療法の再発予防効果 : 長期予後の検討

Abstract

経尿道的に表在性膀胱腫瘍を完全に切除した後1～2週に, BCG 120mgか80mgを生理食塩水40mlに懸濁して, 1週毎に6回, 以後1月毎に10回, 膀胱内に注入した。平均追跡期間74ヵ月で, 22例中4例で延べ10回腫瘍再発が認められた。累積腫瘍非再発率は5年目で78.5%であった。副作用として軽度発熱及び膀胱刺激症状が高頻度に見られた。これらの副作用は一過性であったが, 膀胱刺激症状の為にプロトコール完了前に15例がBCG注入療法を拒否した。注入BCG総量と腫瘍再発との間に関係は認められなかった。膀胱の恒久的構造的・機能的変化, 或いは他の臓器のミコバクテリア感染は認められなかった

Since 1982, we treated 22 patients with superficial bladder cancer via intravesical bacillus Calmette-Guerin (Tokyo 172 strain) for prophylaxis against tumor recurrence. To determine the long-term efficacy and complications of BCG therapy, retrospective analysis was performed. The BCG therapy was initiated one to two weeks after complete transurethral resection of visible tumors. One hundred twenty mg or 80 mg of BCG suspended in 40 ml of 0.9% NaCl solution was instilled into the bladder once a week for 6 times, then monthly for 10 times. Of 22 patients, 10 tumor recurrences were recognized in 4 patients (mean followup 74 months). Recurrent free rate at 5 years was 78.5%. Common side effects were low grade fever and bladder irritability. Although these side effects were self-limiting, 15 patients (68%) refused instillation of BCG before completion of our protocol because of the bladder irritation. No relationship was observed between total dose of BCG instilled and tumor recurrence. Severe side effects such as permanent structural or functional alterations of the bladder or mycobacterial infection of other organs were not observed. Intravesical administration of Tokyo 172 strain of BCG seemed to be safe and useful for long-term prophylaxis of superficial bladder cancer recurrence.