浸潤性膀胱癌でのTURBTと化学放射線療法による膀胱温存療法  [in Japanese] BLADDER PRESERVATION BY CHEMORADIOTHERAPY IN COMBINATION WITH RADICAL TUR-BT IN MUSCLE INVASIVE BLADDER CANCER  [in Japanese]

(目的)Cold resectによるTURBTと化学放射線療法を用いて浸潤性膀胱癌に対する膀胱温存治療を行い,その成績を検討した.(対象・方法)TURBTと化学放射線療法による膀胱温存治療を,浸潤性膀胱癌26例に行った.深達度はT2 : 15例,T3 : 9例,T4 : 2例,異型度は,G2 : 3例,G3 : 23例であった.TURは,進達度診断の正確を期するため,深部筋層まで,止血のための最小限の電気凝固を用いながら生検鉗子で切除した.その後,40Gyの外照射を行い,メソトレキセート30mg/m^2の全身投与,シスプラチン70mg/m^2の動脈内投与を2クール併用した.治療終了後,残存腫瘍の有無をTURで確認した.治療後のTURも膀胱周囲脂肪に至るまで生検鉗子で組織を採取した.(結果)26例中24例がTURBTを施行され,pT0が13例(50%),pT1が9例(35%),pT2が2例(8%)であった.平均観察期間24カ月(3.9〜69.8),中央値21.9カ月で,経過中に筋層浸潤癌として再発した2例に膀胱全摘除術を行った.膀胱温存率は26人中24人,92%であった.遠隔転移は4例(15%)で,全例局所再発は認めなかった.2年疾患特異的生存率は91%であった.重篤な有害事象は認めなかった.(結論)Radical TURBTと化学放射線療法による膀胱温存治療は,浸潤性膀胱癌に対する安全で有効な治療になり得る可能性が示唆された.

(Purpose) To evaluate bladder preservation protocol by radical TUR-Bt and subsequent concurrent chemoradiotherapy in muscle invasive bladder cancer. (Patients and methods) Twenty-six patients with muscle invasive bladder cancer (T2-T4N0M0) were treated with concurrent chemoradiotherapy after transurethral resection of the tumor as much as possible beyond muscle layers. Chemotherapy was consisted of systemic administration of methoterexete (30 mg/m^2 day1 and day 22) and intraarterial infusion of cisplatin (70 mg/m^2, day2 and day 23). The response was evaluated by TUR, urine cytology, CT and/or MRI 4 to 6 weeks after the treatment. (Results) Among 24 evaluable cases, pathological complete response was achieved in 13 cases (50%) and residual tumors were noted in 11 cases (pT1 in 9 and pT2 in 2). During follow-up period up to 69.8 months, Invasive recurrence was observed in 2 cases, superficial recurrence was noted in 5 patients and distant metastasis without evidence of local recurrence was noted in 4 cases. Overall bladder preservation rate was 92%. (Conclusions) The bladder preservation by radical TUR-Bt and chmeradiotherapy is a safe and effective treatment option for muscle invasive bladder cancer.