Intra-arterial chemotherapy for muscle-invasive urinary bladder cancer

Abstract

局所浸潤性膀胱癌(T3-4, N0M0)を有する9例に対して, 骨盤内血流改変術を伴うリザーバーを用いたM-VEG動注療法(methotrexate 40mg, vinblastine4mg, epirubicin 40mg, cisplatin 100mg)を施行し, CR3例, PR3例, NC2例で全体の奏効率は75%であった.PRの3例は根治的膀胱全摘除術を施行したが, 2例にdown-staging(T3→pT1b)が認められた.病理組織学的には, 腫瘍以外の正常膀胱壁には軽度の筋層の線維化を伴った出血性膀胱炎に類似した変化が著しかった

A total of 9 patients with muscle-invasive bladder cancer (T3 or T4N0M0) were treated with a modified intra-arterial M-VEC (IA-M-VEC) regimen beginning in October 1992 to evaluate its therapeutic efficacy, and in 3 evaluable patients who subsequently underwent radical cystectomy, the possibility of bladder preservation was assessed. The responses of the 8 evaluable patients were rated as complete response (CRs) in 3, partial response (PRs) in 3 and no change (NCs) in 2. The objective response rate (PR + CR) was 75%. An obvious down-staging (T3 --> pT1b) was confirmed in 2 of the 3 evaluable patients, suggesting the possibility of bladder preservation. Otherwise similar changes to hemorrhagic cystitis with minimal muscular fibrosis were conspicuous in the normal bladder wall. These pathological findings corresponded with those obtained by dynamic single photon emission computed tomography (D-SPECT) using 99mTC-macroaggregate albumin (99mTC-MAA). Besides a buttock-to-perianal erosion with neuralgia on the injection side, mild to moderate sensory disturbance of the sacral plexus was observed.