抄録
(目的)進行性尿路上皮癌(N2-3,M1)症例に対す IFEP療法(ifosfamide : IFM,etoposide : ETP,cisplatin : CDDP,5-fluorouracil : 5-FU)の治療効果ならびに効果判定における腫瘍マーカーの意義について検討した.(対象と方法)1994年3月から2000年5月までの6年間に来院した進行性尿路上皮癌(N2-3,M1)41症例を対象とした.薬剤はIFM(2g/m^2),5-FU(750mg/m^2),ETP(100mg/m^2),CDDP(20mg/m^2),をそれぞれ連続3日間投与し,原則として3週毎に繰り返した.また,化学療法施行前に,血中CEA,CA19-9,SCCを測定し,高値例ではその後の推移も測定し,化学療法による治療効果と比較検討した.(結果)IFEP療法の奏効率(CR+PR)は53.7%で,生存期間の中央値は10.8カ月,奏効例の効果持続期間は7.5カ月であった.1年,3年累積生存率はそれぞれ59.3%,16.5%で,臓器別の奏効率は,局所病変が54%,リンパ節57%,骨56%,肺50%,肝40%であった.副作用は骨髄抑制が高度であったが,口内炎は稀であった.上記腫瘍マーカー全てを測定した37例の内,治療前に何れかの腫瘍マーカーが異常高値を示した症例は19症例(51%)であり,その内訳は,CEAが7例(19%),CA19-9が13例(35%),SCCが10例(27%)であった.治療前の腫瘍マーカー上昇の有無と,原発巣の部位,転移の広がり及び,患者の生存期間との間に有意な関連を認めなかった.しかし,腫瘍マーカー,特にCEAとCA19-9の減衰は画像上の治療効果と有意に関連し(p<0.05),治療効果判定としての意義が認められた.(結論)IFEP療法は進行性尿路上皮癌の治療として有用であり,その効果判定に腫瘍マーカーが一助となり得ると思われた.
(Purpose) We investigated treatment results of IFEPchemotherapy in patients with advanced urothelial cancer (N2-3, M1) and the usefulness of measuring serum CEA, CA19-9 and SCC to evaluate the treatment response of chemotherapy. (Patients and methods) From March 1994 to May 2000, we treated 41 patients with IFEP therapy consisting of ifosfamide (2g/m^2), 5-fluorouracil (750mg/m^2), etoposide (100mg/m^2) and cisplatin (20mg/m^2), all of which were given daily for 3 consecutive days every 3 weeks. Before initiating the chemotherapy, serum CEA, CA 19-9 and SCC were measured. And in patients with high pretreatment serum concentration, they were serially evaluated and compared with the tumor response assessed by imaging studies and the patients' clinicalcourse. (Results) The response rate of the chemotherapy was 53.7% (CR + PR), with a median survival period being 10.8 months and a median duration of response for the 22 responders being 7.5 months. One and three-year survival rates of all the patients were 59.3% and 16.5%. Respnse rates of primary tumors and metastatic lesions to the lymph node, bone, lung and liver were in 54% and 57%, 56%, 50% and 40%, respectively. Bone marrow toxicity was significant with 1 drug-related death. Before chemotherapy, tumor marker was elevated in 19 patients : CEA in 7, CA19-9 in 13 and SCC in 10. Serum levels of the tumor markers were related neither to the primary and metastatic tumor sites nor to patient' s survival time. However, decline of serum tumor markers after chemotherapy was well related to response of the tumor assessed by imaging studies. (Conclusion) IFEP chemotherapy appears to be active in the treatment of advanced urothelial tumor and serial measurment of serum CEA, CA 19-9 and SCC may be useful in judgement of tumor response to the chemotherapy.
