進行性上部尿路移行上皮癌術後の単腎症例に対する化学療法の臨床的検討
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上部尿路移行上皮癌に対して腎尿管全摘除術を施行後,当科で化学療法を施行した10例(13件)に検討を加えた。評価可能病変を有したのは7件で化学療法終了後の近接効果判定ではCR 2件,PR 4件,NC 1件で,奏効率は86%であった。10例のうちすでに癌死したのが4例でその平均術後生存期間は15ヵ月,現在生存中は6例でその平均術後観察期間は31ヵ月,10例全例での平均術後観察期間は25ヵ月であった。副作用としては脱毛,悪心嘔吐および全身倦怠感は13件,口内炎は5件,肝機能障害は4件に認められた。骨髄機能障害として白血球減少症を3件,貧血を8件,血小板減少症を6件に認めたBetween June, 1987 and December, 1993, ten patients with solitary kidney after total nephroureterectomy for advanced upper urothelial transitional cell carcinoma were treated with chemotherapy (M-VAC or modified M-VAC). This series comprised 6 males and 4 females between 27 and 81 years of age (mean age: 58.5 years). The site of primary lesions was the renal pelvis in one case, ureter in 5 and renal pelvis and ureter in 4. Histologically, these extripated tumors were all identified as transitional cell carcinoma, the stage being pT3 and pT4 in 9 and grade being G3 in 8 of the 10 patients. Among the 13 cases including the 3 cases of recurrence after first line chemotherapy, 7 had lesions suitable for the evaluation. Two of the 7 cases achieved complete response and four achieved partial response, resulting in an 86% response rate. Of the 10 patients, 4 died of metastasis of carcinoma and the others are still alive. The average period after operation among 10 patients was 25 months. Side effects related to this chemotherapy were as follows: general fatigue, nausea or vomiting and alopecia 100%, leucocytepenia (< or = 1,000/mm3) 23%, anemia (RBC < or = 250 x 10(4)/mm3) 62%, thrombocytopenia (< or = 5 x 10(4)/mm3) 46%. However, nephrotoxicity in spite of solitary kidney was not noticed in any patients. From our experience, we suggest that M-VAC or modified M-VAC chemotherapy are safe against patients with a solitary kidney after nephroureterectomy for advanced transitional cell carcinoma of the upper urinary tract.
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