Thrasher J B, Crawford E D
Division of Urology, Duke University Medical Center, Durham, North Carolina.
Urol Clin North Am. 1992 Aug;19(3):529-39.
A variety of intravesical chemotherapeutic agents are now available for the treatment of superficial transitional-cell carcinoma of the bladder. The toxicities associated with these agents may make one more appealing than another in the face of similar efficacies. Intravesical instillations of thiotepa have resulted in incidences of leukopenia of 8% to 54%, of thrombocytopenia of 3% to 31%, and of irritative voiding symptoms of 12% to 69%. Close monitoring of blood counts prior to weekly instillations remains vital in preventing myelosuppressive complications. The complications associated with the intravesical use of mitomycin C are mainly chemical cystitis and contact dermatitis. Additionally, allergic reactions have been documented. Most of these complications respond to cessation of therapy with application of topical steroids as needed. Complications of reduced bladder capacity, bladder-wall calcifications, and myelosuppression are uncommon. Toxicities associated with the use of doxorubicin, epirubicin, and ethoglucid are almost exclusively local and usually described as mild to moderate dysuria, frequency, or urgency. Case reports of systemic reactions to doxorubicin are notable in that the patients responded well to diphenhydramine and, in one severe case, epinephrine. Other adverse effects such as reduced bladder capacity, fever, and nausea and vomiting are very uncommon. New agents, such as mitoxantrone, are undergoing phase I and phase II studies. The ideal agent, which would be highly effective and minimally toxic, remains to be developed.
目前有多种膀胱内化疗药物可用于治疗膀胱浅表性移行细胞癌。在疗效相似的情况下，这些药物的毒性可能会使其中一种比另一种更具吸引力。噻替派膀胱内灌注导致白细胞减少的发生率为8%至54%，血小板减少的发生率为3%至31%，刺激性排尿症状的发生率为12%至69%。在每周灌注前密切监测血细胞计数对于预防骨髓抑制并发症仍然至关重要。膀胱内使用丝裂霉素C相关的并发症主要是化学性膀胱炎和接触性皮炎。此外，还记录了过敏反应。这些并发症大多在停止治疗并根据需要应用局部类固醇后得到缓解。膀胱容量减少、膀胱壁钙化和骨髓抑制等并发症并不常见。使用阿霉素、表阿霉素和乙环氧啶相关的毒性几乎完全是局部性的，通常表现为轻度至中度排尿困难、尿频或尿急。阿霉素全身反应的病例报告值得注意的是，患者对苯海拉明反应良好，在一例严重病例中对肾上腺素反应良好。其他不良反应如膀胱容量减少、发热、恶心和呕吐非常罕见。新的药物，如米托蒽醌，正在进行I期和II期研究。理想的药物，即高效且毒性最小的药物，仍有待开发。
