高齢者の浸潤性膀胱腫瘍に対する膀胱亜全摘併用術中照射術の検討

Abstract

高齢, 合併症等でhigh riskな浸潤性膀胱腫瘍22例に膀胱亜全摘IORTを施行した.G2は27%, G3は73%, T1+T2は22%, T3+T4は73%であった.5年生存率は41%であり, 5年cause-specific survival rateは75%であった.局所再発は, 術後70月で1例認めたのみで局所の制御は良好であった.副作用は1例に骨盤死腔炎を認めたのみであった.高齢者, 全身状態不良の浸潤性膀胱癌例に膀胱全摘術に準ずる侵襲の少ない手術として, 膀胱亜全摘術+術中照射術は有用である

From 1981 to 1994, intra-operative radiotherapy after subtotal cystectomy was performed on 22 patients with invasive bladder carcinoma on whom radical cystectomy could not be recommended because of old age or condition. All the patients received 25 to 30 Gy of radiotherapy focused on trigonum and internal urethral orifice after subtotal cystectomy with uretero-cutaneostomy. Of 22 patients, 15 patients died. Five patients died of bladder cancer, one died of gastric cancer, one died of rectal cancer and the others died of pneumonia, heart failure, sepsis and senility. The five-year survival rate was 41% and the cause-specific five-year survival rate was 75%. Local recurrence was seen only in one patients, who received second intra-operative radiotherapy and recovered well in complete remission. We believe that intra-operative radiotherapy after subtotal cystectomy is useful for patients with invasive bladder carcinoma on whom radical cystectomy could not be recommended because of old age or condition.