局所浸潤性膀胱移行上皮癌の治療におけるneoadjuvant chemoradiotherapyについて --PVB療法およびCAP療法の近接効果に関する検討--

Abstract

1982年6月から6年間に, 奈良県立医科大学泌尿器科および奈良県立奈良病院泌尿器科において入院治療した膀胱癌症例のうち, 遠隔転移の認められない臨床的深達度T3を中心とした局所浸潤性膀胱癌症例22例に対して, neoadjuvant therapyとしてPVB療法あるいはCAP療法と, 放射線療法の併用療法を施行した.1)腫瘍縮小効果について, PR以上の有効症例は, PVB療法施行群で66.7%, CAP療法施行群で33.3%に認められた.2) Downstagingは, PVB療法施行群, CAP療法施行群ともに66.7%に認められた.3)副作用については, 悪心, 嘔吐, 骨髄抑制ともに, CAP療法施行群で出現頻度が高い傾向が認められたが, 以後の治療に支障を来すような重篤なものはみられなかった

A total of 22 patients with locally invasive transitional cell carcinoma of the urinary bladder were treated with neoadjuvant cis-diamminedichloroplatinum (CDDP), vincristine, peplomycin (PVB) or cyclophosphamide, doxorubicin, CDDP (CAP) combined with radiation therapy in our institutes between June, 1982 and May, 1988. Twelve patients were entered into the PVB regimen and the remaining 10 patients into the CAP regimen. In the PVB treated group, clinical response was obtained in 2 complete response (CR) and 6 partial response (PR), 8 out of 12 patients (66.7%). Downstaging was noted in 8 out of 12 patients (66.7%). In the CAP treated group, a clinical response was obtained in 1 of CR and in 2 of PR out of the 9 patients with evaluable lesions (33.3%). Downstaging was noted in 6 out of 9 patients (66.7%). There were no significant side effects in either the PVB or CAP treated groups, and these neoadjuvant therapies were well-tolerated. These results indicated that neoadjuvant PVB or CAP combined with radiation therapy would be useful in the management of invasive bladder cancer.