NEOADJUVANT CHEMOTHERAPY FOR LOCALLY ADVANCED UROTHELIAL CANCER OF THE UPPER URINARY-TRACT
NEOADJUVANT CHEMOTHERAPY FOR LOCALLY ADVANCED UROTHELIAL CANCER OF THE UPPER URINARY-TRACT
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DOI：
10.1159/000282755
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发表时间：
1995-01-01
影响因子：
1.6
通讯作者：
USUI, T
中科院分区：
文献类型：
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作者：
IGAWA, M;URAKAMI, S;USUI, T
目前，以顺铂为基础的多药化疗被认为是晚期和转移性尿路上皮癌最有效的治疗方法。我们在新辅助环境下使用顺铂为基础的多药方案治疗了15例局部晚期上尿路尿路上皮癌患者。给药方案为：M.-VAC（甲氨蝶呤、长春花碱、阿霉素和顺铂）；MEC（甲氨蝶呤、依托泊苷和顺铂）或M-VEC（甲氨蝶呤、长春花碱、表柔比星和顺铂）。所有患者均行全肾输尿管切除术，病理评价疗效。15例患者中2例（13%）达到病理完全缓解，6例（40%）达到病理部分缓解，总缓解率为53%（95%置信限29-77%）。病理完全缓解的中位缓解持续时间为54个月，病理部分缓解的中位缓解持续时间为15.5个月。6名有病理性部分反应的患者中有1名，7名没有缓解的患者中有4名死于癌症。虽然观察到病理反应与预后呈正相关，但需要充分的随访来评估新辅助化疗改善局部上尿路晚期尿路上皮癌患者预后的能力。
Cisplatin-based multiple-drug chemotherapy is currently considered the most effective treatment for advanced and metastatic urothelial cancers. We treated 15 patients with Locally advanced urothelial cancers of the upper urinary tract using the cisplatin-based multiple-drug regimen in a neoadjuvant setting. The regimens administered were: M.-VAC (methotrexate, vinblastine, doxorubicin and cisplatin); MEC (methotrexate, etoposide and cisplatin), or M-VEC (methotrexate, vinblastine, epirubicin and cisplatin). Total nephroureterectomy was performed in all patients and response was evaluated pathologically. Of 15 patients 2 (13%) achieved a pathological complete response, 6 (40%) a pathological partial response, for an overall response rate of 53% (95% confidence limits 29-77%). The median durations of response were 54 months for patients with a pathological complete response and 15.5 months for patients with a pathological partial response. One of six patients with a pathological partial response and 4 of 7 with no remission died of cancer. While a positive relationship between the pathological response and prognosis was observed, adequate follow-up is needed to assess the ability of neoadjuvant chemotherapy to improve the prognosis of patients with locally advanced urothelial cancer of the upper urinary tract.