尿路上皮癌に対する術前化学療法としてのGC療法の近接効果に関する検討

Abstract

Neoadjuvant methotrexate, vinblastin, adriamycin and cisplatin (MVAC) chemotherapy is now recommended for muscle invasive bladder cancer. On the other hand, gemcitabine and cisplatin (GC) is often substituted for MVAC in patients receiving neoadjuvant chemotherapy followed by radical cystectomy, although it not clear whether GC has a similar benefit in this setting. We assessed 27 patients who received MVAC or GC as presurgical or neoadjuvant chemotherapy followed by radical surgery from 2007 to 2011. We evaluated adverse events of each chemotherapy and also the pathological T stage of the primary site, which was indicated to be a prognostic factor in previous reports. Ten patients received GC therapy and 17 patients MVAC. Every MVAC patient received 2 courses of chemotherapy, and 2-7 courses of GC (median 3 courses). Only one patient receiving MVAC (5.9%) and 2 patients receiving GC (20%), achieved pT0 there being no significant difference between the two groups. Although the decrease in platelets was greater in the patients receiving GC than in those receiving MVAC, blood transfusion was needed only in the MVAC group. No patient had to postpone the surgery due to side effects from chemotherapy. The effects of the GC regimen at the primary site of urothelial cancer seem to be similar to those of the MVAC regimen.