Tanaka Toshihiro, Nakashima Yuta, Sasaki Hidenori, Masaki Michio, Mogi Ai, Tamura Kazuo, Takamatsu Yasushi
Division of Medical Oncology, Hematology and Infectious Diseases, Department of Medicine, Fukuoka University, Fukuoka, Japan.
Case Rep Oncol. 2019 Jan 21;12(1):69-75. doi: 10.1159/000496331. eCollection 2019 Jan-Apr.
Combined oral cyclophosphamide and capecitabine (XC) chemotherapy is used for metastatic breast cancer (MBC) patients. We report herein two MBC patients who developed severe hemorrhagic cystitis after XC therapy. Case 1: A 67-year-old woman with MBC had received XC therapy for 2.5 years. After a sudden onset of lower abdominal pain and gross hematuria, cystoscopy revealed a urinary bladder mucosa showing diffuse dilation of the capillaries and a large blood clot. A total dose of 60.8 g cyclophosphamide had been given and the XC regimen was discontinued immediately. The patient experienced frequent episodes of bladder tamponade over 18 months and underwent continuous bladder irrigation and cystoscopic fulguration. Hyperbaric oxygen therapy (HBOT) provided only temporary relief and the patient subsequently developed hemorrhagic shock. A bilateral ureterostomy was eventually performed. Case 2: A 65-year-old woman with MBC was given XC for 3 years, but this was discontinued after she developed new lung lesions. The patient was given a total dose of 78.4 g of cyclophosphamide. A month later, the patient complained of intermittent gross hematuria, which progressed to persistent macroscopic hematuria for 1 week. She underwent continuous bladder irrigation with saline, without an improvement in her bladder tamponade. Subsequently, the bleeding ceased completely after HBOT. Some MBC cases can be controlled for a long time with XC therapy. For those cases, we need to realize that severe hemorrhagic cystitis may occur. Even at a low dose, requires testing periodically for occult blood in the urine to detect the early stages of cystitis.
口服环磷酰胺和卡培他滨（XC）联合化疗用于转移性乳腺癌（MBC）患者。我们在此报告两名接受XC治疗后发生严重出血性膀胱炎的MBC患者。病例1：一名67岁的MBC女性接受XC治疗2.5年。在突然出现下腹痛和肉眼血尿后，膀胱镜检查显示膀胱黏膜毛细血管弥漫性扩张并有一大块血凝块。已给予环磷酰胺总剂量60.8 g，立即停用XC方案。患者在18个月内频繁发生膀胱填塞，接受了持续膀胱冲洗和膀胱镜电灼术。高压氧治疗（HBOT）仅提供了暂时缓解，患者随后发生出血性休克。最终进行了双侧输尿管造口术。病例2：一名65岁的MBC女性接受XC治疗3年，但在出现新的肺部病变后停药。该患者接受的环磷酰胺总剂量为78.4 g。一个月后，患者主诉间歇性肉眼血尿，进而发展为持续性肉眼血尿1周。她接受了生理盐水持续膀胱冲洗，但膀胱填塞情况无改善。随后，HBOT治疗后出血完全停止。一些MBC病例可以通过XC治疗得到长期控制。对于这些病例，我们需要意识到可能会发生严重出血性膀胱炎。即使是低剂量，也需要定期检测尿潜血以发现膀胱炎的早期阶段。
