Kuroda M, Kotake T
Dept. of Urology, Center for Adult Diseases, Osaka.
Gan To Kagaku Ryoho. 1994 Oct;21 Suppl 3:362-9.
Conventional treatments such as surgery and radiotherapy for deeply invasive, clinically non-metastatic bladder cancer are associated with cure in less than 30% of cases. This has led to the search for new approaches to therapy. Based on the excellent results with combination chemotherapy such as M-VAC in patients with advanced disease, neoadjuvant or adjuvant chemotherapy has been advocated to improve survival. Twenty patients with primary invasive bladder cancer who underwent radical cystectomy received postoperative adjuvant chemotherapy using a CAP (cyclophosphamide, doxorubicin and cisplatin) or modified M-VAC (methotrexate, vinblastine, pirarubicin and cisplatin) regimen. Sixteen of the patients were treated with CAP and four with the modified M-VAC. Of the 20 patients, 17 had transitional cell carcinoma with or without non-transitional cell elements. All of the patients had tumors with a histological grade of G2 (six cases) or G3 (14 cases). As for lymph node metastasis, there were 10 N0 cases, three N1 cases, six N2 cases, and one N3 case. The five-year survival rate of these 20 patients was 65.9%, while that of 49 patients not administered any adjuvant chemotherapy was 29.9%. Regarding toxicity, both adjuvant chemotherapy regimens in this study were generally well tolerated. The most common toxic effects were gastrointestinal symptoms, alopecia and myelosuppression. Twenty other patients with invasive transitional cell carcinoma of the bladder received two or three cycles of neoadjuvant chemotherapy using the modified M-VAC or MEC (methotrexate, epirubicin and cisplatin) regimen prior to radical cystectomy or partial cystectomy. Of 19 evaluable patients who received neoadjuvant chemotherapy, a complete response was observed in two (10%), a partial response in 11 (55%), and no change in six (30%). The overall response rate was 65%. The five-year survival rate of 20 patients who received neoadjuvant chemotherapy was 74.2%. Regarding toxicity, one patient died of a bowel complication after surgery, and the complication was suggested to be drug-induced.
对于深度浸润、临床无转移的膀胱癌，手术和放疗等传统治疗方法的治愈率不到30%。这促使人们寻找新的治疗方法。基于晚期疾病患者采用如M-VAC等联合化疗取得的优异效果，有人主张采用新辅助或辅助化疗来提高生存率。20例接受根治性膀胱切除术的原发性浸润性膀胱癌患者术后采用CAP（环磷酰胺、阿霉素和顺铂）或改良M-VAC（甲氨蝶呤、长春碱、吡柔比星和顺铂）方案进行辅助化疗。其中16例患者接受CAP治疗，4例接受改良M-VAC治疗。20例患者中，17例为伴有或不伴有非移行细胞成分的移行细胞癌。所有患者的肿瘤组织学分级为G2（6例）或G3（14例）。至于淋巴结转移情况，N0病例10例，N1病例3例，N2病例6例，N3病例1例。这20例患者的五年生存率为65.9%，而49例未接受任何辅助化疗的患者的五年生存率为29.9%。关于毒性，本研究中的两种辅助化疗方案总体耐受性良好。最常见的毒性反应是胃肠道症状、脱发和骨髓抑制。另外20例浸润性膀胱移行细胞癌患者在根治性膀胱切除术或部分膀胱切除术之前，采用改良M-VAC或MEC（甲氨蝶呤、表柔比星和顺铂）方案接受了两到三个周期的新辅助化疗。在19例接受新辅助化疗且可评估的患者中，观察到2例（10%）完全缓解，11例（55%）部分缓解，6例（30%）无变化。总缓解率为65%。20例接受新辅助化疗的患者的五年生存率为74.2%。关于毒性，1例患者术后死于肠道并发症，推测该并发症为药物引起。
