Uyama T, Moriwaki S, Yokozeki A, Kitada K, Higa I, Shiotsu T, Fujita J
Department of Urology, Shikoku Cancer Center Hospital, Matsuyama, Japan.
Cancer Chemother Pharmacol. 1987;20 Suppl:S10-4. doi: 10.1007/BF00262477.
Twenty patients with bladder cancer (T1, 3 patients; T2, 6 patients; T3, 8 patients; T4a, 3 patients) were preoperatively treated with intra-arterial doxorubicin chemotherapy in combination with low-dose irradiation. The originally scheduled operations were as follows: total cystectomy in 16 patients (T1 + cis, 1 patients; T2, 5 patients; T3, 7 patients; T4a, 3 patients), segmental cystectomy in 2 patients, and transurethral resection in 2 patients. The total dose of doxorubicin ranged from 120 to 540 mg (251.5 +/- 100.2 mg), and that of irradiation was from 4 to 36 Gy (24.4 +/- 7.3 Gy). Clinical and pathological effects were evaluated in all of the cases. Clinically, complete remission (CR) was observed in 14 cases (70.0%), partial remission (PR) was seen in 3 cases, a minor response (MR) occurred in 2 cases, and no response (NR) was seen in 1 patient; non patient showed progressive disease (PD). The pathological effects (according to the criteria of Shimosato et al.) were as follows: grade IV was seen in 10 cases, grade III in 3 cases, and less than grade II in 7 cases; however, viable tumor cell were not seen in 13 (65.0%) of the 20 cases. The bladder was preserved in 13 (81.3%) of the 16 cases for which total cystectomy had been recommended. All of the patients were followed up for periods ranging from 3 to 54 months (26.3 +/- 16.5 months), during which time 6 patients (30.0%) died (3 with cancer, 1 without cancer, and 2 unknown causes). The actual survival rate according to the stage of disease was 100.0% at 50 months in T1-T2 and 40.9% at 54 months in T3-T4a. In T3-T4a, the actual survival rate in pathologically complete responders was 60% (relative rate 68.8%) at 54 months, and the actual survival rate in incomplete responders was 25.0% (relative rate 27.1%) at 36 months. The results of our study are encouraging, especially in T1-T2 and T3-T4a cases, who showed a complete response. It is concluded that doxorubicin intra-arterial chemotherapy combined with low-dose irradiation could be the first treatment of choice for locally invasive bladder cancer.
20例膀胱癌患者（T1期3例；T2期6例；T3期8例；T4a期3例）术前行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：16例行全膀胱切除术（T1 + 原位癌1例；T2期5例；T3期7例；T4a期3例），2例行部分膀胱切除术，2例行经尿道切除术。阿霉素总剂量为120至540 mg（251.5±100.2 mg），放疗剂量为4至36 Gy（24.4±7.3 Gy）。对所有病例进行了临床和病理疗效评估。临床上，14例（70.0%）观察到完全缓解（CR），3例部分缓解（PR），2例轻度缓解（MR），1例无缓解（NR）；无患者出现疾病进展（PD）。病理疗效（根据下里佐等人的标准）如下：IV级10例，III级3例，II级以下7例；然而，20例中有13例（65.0%）未见存活肿瘤细胞。在建议行全膀胱切除术的16例患者中，13例（81.3%）保留了膀胱。所有患者随访3至54个月（26.3±16.5个月），在此期间6例（30.0%）患者死亡（3例死于癌症，1例非癌症原因，2例死因不明）。根据疾病分期，T1 - T2期50个月时实际生存率为100.0%，T3 - T4a期54个月时为40.9%。在T3 - T4a期，病理完全缓解者54个月时实际生存率为60%（相对率68.8%），不完全缓解者36个月时实际生存率为25.0%（相对率27.1%）。我们的研究结果令人鼓舞，尤其是在T1 - T2期和T3 - T4a期显示完全缓解的病例中。结论是，阿霉素动脉内化疗联合低剂量放疗可能是局部浸润性膀胱癌的首选初始治疗方法。
