膀胱腫瘍に対するcis-Diamminedichloroplatinum (2)の膀胱内注入に関する基礎的研究 2: 膀胱腫瘍患者におけるcis-Diamminedichloroplatinumの膀胱内注入による影響について

Abstract

1)膀胱腫瘍患者にDDP膀胱内注入療法をおこなったが, 膀胱から血中への移行は少なく局所的毒性も少なかった.2)膀胱全摘術を予定した1症例に術前10日間の連日注入をおこない, 大星・下里の効果判定基準でgrade 2-Bの抗腫瘍効果を得た.3)再発予防を目的としたDDPの長期間歇的膀胱内注入療法を16例に試みたが, 4例にアレルギー様反応が出現したため, すべての症例についてDDP膀胱内注入療法を中止した

This study was performed to determine whether intravesical Cis-Diamminedichloroplatinum (II) (DDP), one of the most effective agents in the treatments of advanced bladder cancer, is applicable for prophylaxis and/or definitive treatment of superficial bladder cancers. Six patients were instilled 10 mg/20 ml of DDP immediately after TUR-Bt, but no remarkable elevation of plasma platinum concentration was observed. In one patient planned to have total cystectomy, 20 mg/40 ml of DDP was instilled daily for 10 days. No remarkable changes in symptom and blood examination was found during the instillation periods. Transitional cell carcinoma of grade 2 was necrosed extensively, but minimum cellular injury was observed in normal mucosa. Tissue platinum concentration was 3.19 micrograms/g. wet in carcinoma and 0.28 microgram/g. wet in normal mucosa. Longterm prophylactic instillation of 20 mg/40 ml of DDP was performed in 16 patients starting immediately after TUR-Bt. As the side effects of DDP instillation, contracted bladder was observed in one patient and allergic reactions, such as flush of the skin and dyspnea, were observed in 4 cases. These allergic reactions were happened suddenly after 15 approximately 19 times of DDP instillation without any prelude. At present, intravesical instillation of DDP seems to cause minimal irritation of bladder and absorption through the bladder wall, but clinical trials of intravesical DDP should be taken under careful observation until the allergic reaction by intravesical DDP are clarified.