Cis-diamminedichloroplatinum,Adriamycin,5-Fluorouracilによる進行性尿路上皮癌の治療経験 - 殊に深部浸潤性尿路上皮癌の補助化学療法について -

Abstract

1) CDDP, ADM, 5-FUによる多剤併用療法に著効を示した転移性尿路上皮癌の1例を報告し, 同様のregimenでの深部浸潤性尿路上皮癌に対しての補助化学療法の有効性について検討した.2)補助化学療法を施行し, 1年以上followしえた7例中, 1例にのみ局所再発を認めただけであり, 本化学療法は, 腫瘍再発に関しては有効である.3) Toxicityとして, 全身倦怠感, 嘔気, 嘔吐, 脱毛は程度の差はあれ全例に認めたが, 強い骨髄抑制は認められなかった.toxicityのため薬剤の減量を必要とした症例が7例中3例あった.4)補助化学療法では, 初回に最も有効な薬剤でmicrometastasisを根絶させることが重要である.現時点では, CDDP, ADMの組み合わせを基礎とした多剤併用療法が最も有効と考えられる.5)尿路上皮癌患者が高齢者に多いことを考慮すると, 補助化学療法における年齢因子は非常に重要と思われ, これを考慮に入れた投与scheduleの決定が必要である

The combination chemotherapy including cis-diamminedichloroplatinum (CDDP), adriamycin (ADM) and 5-fluorouracil (5-FU) is reported as one of the most effective regimens of urothelial cancer. We experienced one patient who had multiple metastatic urothelial cancer in the lung, liver and brain and who showed complete response, even in short duration, by this regimen. Since then, we have been using this regimen as the adjuvant chemotherapy of the invasive urothelial cancer. This regimen consists of 15 mg/m2 CDDP on days 1 to 5, 30 mg/m2 ADM on day 1 and 300 mg/m2 5-FU on days 1 to 5, and is repeated 3 times for 3 to 4 weeks. If toxicity is intolerable, the dosage of CDDP and ADM was decreased in thirty percent. As the maintenance, tegaful was administrated oral or suppository for 1 to 2 years. Seven cases which were followed for at least 12 months were evaluated. In one patient, local recurrence appeared after 16 months, but the other patients were disease free. General malaise, nausea, vomiting and alopecia were recognized in all patients in various degrees, but severe myelosuppression did not appear. Because of the toxicity, three patients had to have reduced dosage. In the adjuvant chemotherapy the most effective regimen should be used in the first therapy to eradicate the micrometastasis. At present, the combination chemotherapy of CDDP and ADM is the most effective for urothelial cancer as reported by many authors. Although the number of patients and the duration of follow up are inadequate to evaluate this adjuvant chemotherapy, we believe that this regimen is effective since invasive urothelial cancer usually recurs within 2 years.