[Therapeutic experiences of cis-diamminedichloroplatinum, adriamycin and 5-fluorouracil combination chemotherapy in advanced urothelial cancer, with special reference to adjuvant chemotherapy in invasive urothelial cancer].

The combination chemotherapy including cis-diamminedichloroplatinum (CDDP), adriamycin (ADM) and 5-fluorouracil (5-FU) is reported as one of the most effective regimens of urothelial cancer. We experienced one patient who had multiple metastatic urothelial cancer in the lung, liver and brain and who showed complete response, even in short duration, by this regimen. Since then, we have been using this regimen as the adjuvant chemotherapy of the invasive urothelial cancer. This regimen consists of 15 mg/m2 CDDP on days 1 to 5, 30 mg/m2 ADM on day 1 and 300 mg/m2 5-FU on days 1 to 5, and is repeated 3 times for 3 to 4 weeks. If toxicity is intolerable, the dosage of CDDP and ADM was decreased in thirty percent. As the maintenance, tegaful was administrated oral or suppository for 1 to 2 years. Seven cases which were followed for at least 12 months were evaluated. In one patient, local recurrence appeared after 16 months, but the other patients were disease free. General malaise, nausea, vomiting and alopecia were recognized in all patients in various degrees, but severe myelosuppression did not appear. Because of the toxicity, three patients had to have reduced dosage. In the adjuvant chemotherapy the most effective regimen should be used in the first therapy to eradicate the micrometastasis. At present, the combination chemotherapy of CDDP and ADM is the most effective for urothelial cancer as reported by many authors. Although the number of patients and the duration of follow up are inadequate to evaluate this adjuvant chemotherapy, we believe that this regimen is effective since invasive urothelial cancer usually recurs within 2 years.