Uyama T, Higa I, Shiotsu T, Fujita J, Yamamoto A, Aga Y
Gan To Kagaku Ryoho. 1987 Jul;14(7):2293-9.
Fifteen patients with non-disseminated bladder cancer (T1:2, T2:2, T3:8, T4:3) were preoperatively treated with intra-arterial doxorubicin chemotherapy in combination with low-dose irradiation. The originally scheduled operations had been as follows; total cystectomy in 11, segmental cystectomy in 2, and TUR- or SVR-Bt in 2. The total dose of doxorubicin ranged from 120 to 540 mg/body, with an average of 312.7 mg/body and that of irradiation was from 4 to 34 Gy with an average of 24.0 Gy. Clinically, in the early phase of the study, complete remission (CR) was revealed in 10 (66.7%), and partial remission (PR) in 2 (13.3%). The bladder was preserved in 9 of 11 (81.8%) cases in which total cystectomy had been recommended. Pathological effects according to the criteria presented by Shimosato, Oboshi and Baba, were as follows; grade IV in 6 cases (40.0%), grade III in 2 (13.3%), grade II in 4 (26.7%) and grade I or 0 in 3 (20.0%). Therefore, viable tumor cells were not seen in 8 of 15 (53.3%) cases. Vesical non-recurrent rate in the cases with bladder preservation was 56.2% at 48 months by simple mode and 44.6% by accumulated mode. Survival in 13 cases (T2-T4) by pathological effects was 75.0% at 48 months in the grade IV and III group (n = 8), and 40.0% at 42 months in the grade II or less group (n = 5). The results obtained from this study seem encouraging, especially in the group where the pathological effects were grade IV or III, and leads to the conclusion that doxorubicin intra-arterial chemotherapy, combined with low-dose irradiation, could be a first-choice treatment for locally invasive bladder cancer.
15例非播散性膀胱癌患者（T1期2例、T2期2例、T3期8例、T4期3例）术前接受动脉内阿霉素化疗联合低剂量放疗。原计划的手术方式如下：全膀胱切除术11例、部分膀胱切除术2例、经尿道膀胱肿瘤切除术或膀胱部分切除术2例。阿霉素的总剂量为120～540mg/人，平均312.7mg/人；放疗剂量为4～34Gy，平均24.0Gy。临床上，在研究早期，10例（66.7%）达到完全缓解（CR），2例（13.3%）达到部分缓解（PR）。在建议行全膀胱切除术的11例患者中，9例（81.8%）保留了膀胱。根据下里、小星和马场提出的标准，病理效应如下：IV级6例（40.0%）、III级2例（13.3%）、II级4例（26.7%）、I级或0级3例（20.0%）。因此，15例中有8例（53.3%）未见存活肿瘤细胞。保留膀胱的患者膀胱无复发生存率，单纯模式下48个月时为56.2%，累积模式下为44.6%。根据病理效应，13例（T2～T4期）患者中，IV级和III级组（n = 8）48个月时生存率为75.0%，II级及以下组（n = 5）42个月时生存率为40.0%。本研究结果似乎令人鼓舞，尤其是在病理效应为IV级或III级的组中，得出动脉内阿霉素化疗联合低剂量放疗可作为局部浸润性膀胱癌首选治疗方法的结论。
