Sekine H, Mine M, Ohya K, Kaneoya F, Yokokawa M
Department of Urology, University Hospital, Mizonokuchi.
Hinyokika Kiyo. 1992 Feb;38(2):155-9.
From January, 1987 through January, 1990, partial cystectomy was performed for 4 (18%) of 22 patients with invasive bladder cancer who had received neoadjuvant intra-arterial chemotherapy. The criteria of patient selection for partial cystectomy were: 1) invasive bladder cancer showing good response (greater than or equal to PR) to neoadjuvant chemotherapy, 2) solitary or localized tumor that can be eradicated by segmental resection, and 3) tumor of stage T3 or less. As a rule, cisplatinum (100 mg/m2) and THP-adriamycin (40 mg/m2) were administered selectively to the internal iliac artery by one-shot infusion. Concurrently, sodium thiosulfate (10 g/m2), a neutralizing agent against cisplatinum, was administered intravenously. All four patients had achieved clinical complete responses by one or two courses of intra-arterial chemotherapy, and then underwent partial cystectomy with pelvic lymphadenectomy. Pathological examination revealed pTONO in two patients, and the remains were pT3aNO and pT3bN1. After the mean follow-up of 24 months, three of them are alive with no evidence of disease, and also with normal bladder and sexual functions. However, one with pT3bN1 tumor underwent total cystectomy 5 months later for local recurrence (pT4b) and had died of cancer 18 months later. Neoadjuvant intra-arterial chemotherapy followed by partial cystectomy should be the most applicable conservative therapy with high radicality for invasive bladder cancer, when: 1) the patient has localized invasive cancer showing good response (greater than or equal to PR) to neoadjuvant chemotherapy, 2) the tumor is stage T3a or less and without findings of tentacular invasion (INF gamma) by pre-operative biopsy, and 3) pre-operative multiple biopsy is performed as deeply as possible along the prearranged incision line.
从1987年1月至1990年1月，22例接受新辅助动脉内化疗的浸润性膀胱癌患者中有4例（18%）接受了膀胱部分切除术。膀胱部分切除术的患者选择标准为：1）对新辅助化疗显示出良好反应（大于或等于PR）的浸润性膀胱癌；2）可通过节段性切除根除的孤立或局限性肿瘤；3）T3期或以下的肿瘤。通常，顺铂（100mg/m²）和吡柔比星（40mg/m²）通过一次性输注选择性地注入髂内动脉。同时，静脉注射硫代硫酸钠（10g/m²），一种顺铂的中和剂。所有4例患者在接受一或两个疗程的动脉内化疗后均达到临床完全缓解，然后接受膀胱部分切除术及盆腔淋巴结清扫术。病理检查显示2例患者为pTONO，其余为pT3aNO和pT3bN1。平均随访24个月后，其中3例存活且无疾病证据，膀胱和性功能也正常。然而，1例pT3bN1肿瘤患者5个月后因局部复发（pT4b）接受了全膀胱切除术，并于18个月后死于癌症。对于浸润性膀胱癌，新辅助动脉内化疗后行膀胱部分切除术应是最适用的具有高根治性的保守治疗方法，当：1）患者患有对新辅助化疗显示出良好反应（大于或等于PR）的局限性浸润性癌；2）肿瘤为T3a期或以下且术前活检未发现触须样浸润（INFγ）；3）术前沿预定切口线尽可能深地进行多次活检。
