表在性膀胱腫瘍に対するEpirubicin hydrochlorideの膀胱内注入療法 : 再発予防効果と上皮内癌の治療効果

Abstract

1990年5月～1993年5月の間に経尿道切除後に本剤の膀胱内注入療法を週1回で10回行った表在性膀胱腫瘍52例を, 1群:CIS(上皮内癌)及び原発腫瘍にCISを伴う, 2群:原発巣が多発性, 3群:原発巣は単発であるが病理的にpT1, G3である, に大別した.1群ではCIS治療, 2・3群では再発予防の為に行った.非再発率は1群及び2・3群で12ヵ月でそれぞれ67及び77%, 後者では24ヵ月で42%であった.主な副作用は膀胱刺激症状, 血尿, 及び膿尿であった.重症副作用は萎縮膀胱2例, 出血性膀胱炎3例であった

Between May 1990 and May 1993 we performed intravesical instillation of epirubicin hydrochloride (EPI) to 52 patients with superficial bladder tumor after transurethral resection. Indications of these instillations were classified into 3 groups. Group 1 was for carcinoma in situ (CIS) or the CIS other than the original tumor, group 2 was for multiple tumors, and group 3 was for pT1G3 tumor. Intravesical instillations of the drug were given weekly for 10 weeks and close follow-up examinations were performed routinely. Group 1 was treated for CIS, whereas group 2 and group 3 were prophylactic instillations. The disease-free rate in group 1 was 67%, and that in group 2 and group 3 was 77% at 12 months, and 42% at 24 months according to the Kaplan-Meier method. The major side effects of the instillations were bladder irritation, hematuria and pyuria. However, we experienced 5 patients with severe side effects; 2 of atrophic bladder and 3 of hemorrhagic cystitis. Although this study was conducted retrospectively, these findings suggest that intravesical instillations of EPI can be as effective as other drugs, such as mitomycin C, and doxorubicin, by adding the maintenance instillation or by elevating the drug density and shortening the instillation time.