浸潤性膀胱癌に対する制癌剤感受性試験を利用した術前動注化学療法の治療成績

Abstract

局所浸潤性膀胱癌9例に対し術前動注化学療法(IAC)を施行する際, 生検組織より行った制癌剤感受性試験の結果に基づき制癌剤を選択した.これに引き続いて膀胱全摘を行い, 治療効果を摘出標本の組織学的効果, 遠隔成績より検討した. 1)全例において制癌剤感受性の評価が可能であった.感受性試験の結果に基づくIACの組織学的効果はG3が3例, G2, G1b, G1aがそれぞれ2例であり, 結局9例中3例においてpCR, 4例でdownstagingが得られた. 2)平均観察期間38.9ヵ月の時点において, 9例中7例でNEDが保たれていたが, 2例は術後2年以内に遠隔転移により癌死した

We investigated the clinical usefulness of individualization of chemotherapeutic regimen in neoadjuvant intra-arterial chemotherapy for locally invasive bladder cancer. Anticancer drugs were selected according to the results of an in vitro chemosensitivity test (collagen matrix assay or succinic dehydrogenase inhibition test). Nine patients with locally invasive bladder cancer received 1 to 4 courses of neoadjuvant intra-arterial chemotherapy, followed by radical cystectomy. Histopathological responses in the cystectomized specimens were grade 3 in 3 cases, grade 2 in 2, grade 1b in 2 and no response in 2. Pathologically, a complete response and downstaging were observed in 3 and 4 cases, respectively. Seven of the 9 patients were alive no evidence of disease with a mean follow-up period of 38.9 months, whereas 2 patients died of metastasis within 2 years. Six of the 7 patients who showed a complete response or down staging have been free of recurrence. These findings suggest that our chemotherapeutic strategy may improve the prognosis for locally invasive bladder cancer.