Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Int J Clin Oncol. 2010 Oct;15(5):433-9. doi: 10.1007/s10147-010-0079-0. Epub 2010 Apr 21.
Our aim was to evaluate the clinical significance of the negative-balance isolated pelvic perfusion (NIPP) method using ultrahigh-dose cisplatin (CDDP) for ten cases of invasive bladder cancer with poor risk such as high-grade cancer, advanced clinical stage, or appearance of hydronephrosis.
A CDDP dosage of 200-300 mg/body was used under the NIPP method. To confirm safety and efficacy, peripheral blood, pelvic arterial blood, pelvic venous blood, and urine were collected for sampling of the platinum (Pt) concentrations. These samples were investigated and compared with those following previous intraarterial chemotherapy sessions.
The Pt concentrations in pelvic blood under intraarterial chemotherapy and NIPP were 5.97 ± 2.06 and 24.15 ± 4.61 μg/ml, respectively. By contrast, the Pt concentration in peripheral blood under NIPP was half the level under conventional intraarterial chemotherapy. No severe adverse events were found in terms of gastrointestinal and hematological toxicity, but renal function was impaired in some cases. Pathological or surgical complete response (CR) was achieved in five of ten cases (50%) in spite of the group being poor risk, and bladder preservation was possible in all the CR cases. Patients with CR experienced survival in all terms of observation.
The NIPP method was able to deliver high levels of CDDP concentration in pelvis cavity without severe adverse events. The NIPP method makes it possible to achieve CR for the patients with invasive bladder cancer with poor risk who rejected cystectomy.
我们的目的是评估使用超高剂量顺铂（CDDP）进行 10 例高危浸润性膀胱癌（如高级别癌症、晚期临床分期或出现肾盂积水）的阴性平衡孤立骨盆灌注（NIPP）方法的临床意义。
在 NIPP 方法下使用 200-300mg/ 体的 CDDP 剂量。为了确认安全性和疗效，采集外周血、骨盆动脉血、骨盆静脉血和尿液进行铂（Pt）浓度采样。将这些样本与以前的动脉内化疗疗程的样本进行比较和研究。
动脉内化疗和 NIPP 下骨盆血中的 Pt 浓度分别为 5.97±2.06μg/ml 和 24.15±4.61μg/ml。相比之下，NIPP 下外周血中的 Pt 浓度是常规动脉内化疗的一半。在胃肠道和血液学毒性方面没有发现严重的不良事件，但在一些病例中肾功能受损。尽管该组为高危组，但 10 例中有 5 例（50%）达到了病理或手术完全缓解（CR），并且所有 CR 病例均可以保留膀胱。所有观察期的 CR 患者均存活。
NIPP 方法能够在不发生严重不良事件的情况下在骨盆腔内输送高浓度的 CDDP。NIPP 方法使拒绝膀胱切除术的高危浸润性膀胱癌患者有可能实现 CR。
