局所浸潤性膀胱癌における術前化学療法(M-VAC)

Abstract

1)臨床病期T2-T4, N0, M0の膀胱癌症例8例に術前M-VAC療法を2コース行い, 膀胱全摘術を7例に, TUR biopsyを1例におこなった.2)膀胱全摘術を行った7例のうち5例に有効と考えられた.3)観察期間は平均26ヵ月で, 1例が術後27ヵ月で癌死したが, 7例は再発なく生存している.4)副作用として重篤なものはなく全例full doseの投与が可能であった.5)術前化学療法の効果を論ずる際に, 臨床病期の決定においてどの程度TURを行うかが問題である

Eight patients with locally invasive bladder cancer (stages T2-T4, N0, M0; 7 men and 1 woman; mean age, 72.0 years; age range, 56 to 80 years) were treated with 2 cycles of neoadjuvant chemotherapy consisting of methotrexate, vinblastine, adriamycin and cisplatin (M-VAC). Seven of them underwent radical cystectomy after chemotherapy, while the bladder was preserved in one patient. Seven patients were free of disease during a mean follow-up period of 26.2 months (range 20-30 months). However, one patient whose pathological stage was pT2, N1 died with disease 27 months after radical cystectomy. The patient whose bladder had been preserved showed no recurrence after a follow-up period of 27 months. Pathological examination of the resected specimen after chemotherapy revealed no tumor tissue in three patients; one with negative cytology and two with positive cytology. Downstages were observed in two patients. Results showed that the toxicity of neoadjuvant M-VAC therapy is acceptable and that M-VAC therapy is effective against locally invasive transitional cell carcinoma of the bladder. The problem remains of how to assess the clinical stage more accurately before chemotherapy and radical cystectomy.