浸潤性膀胱癌に対する経尿道的腫瘍切除後の low-dose Cisplatin 動注化学療法併用放射線療法の検討 A RESULT OF INTRA-ARTERIAL LOW-DOSE CISPLATIN COMBINED WITH IRRADIATION AFTER TRANSURETHRAL SURGERY FOR INVASIVE BLADDER CANCER

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膀胱全摘除術が施行できない浸潤性膀胱癌23例(T2 5 例,T3a 3 例,T3b 10例,T4 5 例,N0 18例,N1 2例,N2 3 例)に対してTUR-Bt後,内腸骨動脈に置いたリザーバーよりcisplatinを少量ずつ毎日投与し,同時に放射線治療を施行した.放射線治療は全骨盤に40 Gyと,追加照射として膀胱に限局して左右対向 2 門で20 Gyを照射することを基本とし,総線量の平均が58.1 Gyであった.効果判定は,治療後 1~2 週間後に膀胱鏡で行った.治療終了後は外来通院で動注リザーバーより抗癌剤を 2 週に 1 度注入し,およそ 6 カ月に 1 度のTUR-Btによる効果判定を行った.経過観察期間は25~123カ月,中央値72カ月,平均69カ月,生存期間は19~117カ月,中央値66カ月,平均63カ月であった.全症例の 2 年,3 年,5 年生存率は84 %,78 %,63 %であった.他病死が 6 例で,2 年,3 年,5 年原病生存率は94 %,86 %,86 %,無病生存率は,2 年80 %,3 年80 %,5 年66 %であった.有害事象は,下痢がGrade 2 を 3 例に認め,膀胱炎はGrade 3 が 1 例,Grade 4 が1 例(晩期障害として 7 年後に膀胱膣瘻形成)で,血液毒性はGrade 3 を 1 例に認めた.また,化学療法によると思われる有害事象はGrade 2 の末梢神経炎を 2 例に認めた.再発は全23例中 3 例(13 %)に認め,3 例とも遠隔転移例であった.浸潤性膀胱癌に対する経尿道的腫瘍切除後のlow-dose Cisplatin 動注化学療法併用放射線療法は,高齢者にも比較的安全で根治の期待できる有用な治療法であると考えられる.

Background: The combination of radiotherapy and cisplatin-based chemotherapy has proved to be an effective treatment for bladder carcinoma in many clinical studies. Intra-arterial approaches to chemotherapy have been developed to reduce systemic toxicities and improve response rates. This study was designed to determine the effectiveness of intra-arterial chemotherapy combined with radiotherapy in the treatment of patients with invasive bladder carcinoma. The objectives were to evaluate the response rate, toxicity, and survival rate.<br>Materials and Methods: Twenty-three patients with invasive bladder cancer at clinical stage T2-4 N0-3 M0 who had residual tumor after transurethral resections, were treated with daily intra-arterial cisplatin (5-10 mg/day total, 110-130 mg) and concurrent radiation (2 Gy/day; total, 50-60 Gy). All patients received unilateral or bilateral placement of reservoir to perform daily cisplatin infusion after alteration of intrapelvic blood flow by coil embolizations.<br>Results: A clinical complete response, defined as no viable tumor cell in the biopsy specimen, was observed in 16 (70%) patients, and a partial response was observed in 7 (30%). After a median follow-up of 72 months (range, 25-123 months), 15 patients (65%) were alive. Two cancer-related deaths were observed. Cause-specific and disease-free survival rates at 5 years were 86% and 66%, respectively. Grade3 acute toxic reactions included cystitis in one patient, leukopenia in one, and other forms of toxicity due to chemotherapy, including neuropathy in two patients were tolerable. The regimen was well tolerated, with no severe systemic or local toxicities.<br>Conclusions: The high rates of response and survival observed indicate that this combined intra-arterial chemotherapy and radiotherapy regimen would be useful in the management of invasive bladder carcinoma.

収録刊行物

  • The Journal of JASTRO = 日本放射線腫瘍学会誌  

    The Journal of JASTRO = 日本放射線腫瘍学会誌 18(4), 225-233, 2006-12-25 

    Japanese Society for Therapeutic Radiology and Oncology

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各種コード

  • NII論文ID(NAID)
    10021282427
  • NII書誌ID(NCID)
    AN10123988
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    10409564
  • データ提供元
    CJP書誌  J-STAGE 
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