[Chemotherapy of invasive bladder cancer].
[Chemotherapy of invasive bladder cancer].
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浸润性膀胱癌的化疗[J].
DOI：
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发表时间：
1991
期刊：
影响因子：
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通讯作者：
T. Kotake
中科院分区：
文献类型：
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作者：
T. Kotake
本文就浸润性膀胱癌全身化疗的结果作一综述。尿路移行细胞癌，包括膀胱、肾盂和输尿管，对化疗有中等反应。许多化疗药物已经单独或联合进行了研究。直到大约10年前，阿霉素(ADM)一直是研究最多的治疗浸润性膀胱癌的药物。然而，单一药物和与ADM联合使用的结果一直令人失望；总体应答率约为20%。随着顺铂(CDDP)的引入，浸润性膀胱癌的化疗疗效显著提高。单用顺铂320例，有效率30%，甲氨蝶呤236例，有效率29%，阿霉素248例，有效率17%，长春花碱38例，有效率16%，丝裂霉素C 42例，有效率13%。目前治疗这种疾病最重要的药物是顺铂和甲氨蝶呤，其次是阿霉素和长春新碱。最近在晚期膀胱癌患者中进行的有限试验数据表明，使用这些药物的联合化疗方案可诱导高比例的完全缓解(CR)，总有效率在50%至70%之间，中位有效时间超过6个月。最有效的联合方案是M-VAC(CDDP+MTX+ADM+VBL)、CMV(CDDP+MTX+VBL)、CM(CDDP+MTX)和CISCA(CDDP+ADM+环磷酰胺)。M-VAC、CMV、CM和CISCA联合方案的有效率分别为57%、57%、46%和46%。然而，这些药物具有很大的毒性，它们的组合仍然被认为过于危险。在接受这些联合方案的患者中，有20%到40%的患者达到了CR，这导致了辅助和新辅助化疗。
This article is a review of the results of systemic chemotherapy for invasive bladder cancer. Transitional cell carcinoma of the urinary tract including the urinary bladder, renal pelvis and ureter has been moderately responsive to chemotherapy. Many chemotherapeutic agents have been studied singly or in combination. Until about 10 years ago, adriamycin (ADM) was the most studied agent for treatment of invasive bladder cancer. However, the results of single agents and combination with ADM have been disappointing; the overall response rate was approximately 20%. With the introduction of cisplatin (CDDP), the efficacy of chemotherapy for invasive bladder cancer has improved significantly. As single agents, CDDP has a response rate of 30 % in 320 cases, methotrexate (MTX), 29% in 236 cases, ADM, 17% in 248 cases, vinblastine (VBL), 16% in 38 cases, and mitomycin C, 13% in 42 cases. Presently the most important agents in the treatment of this disease are CDDP and MTX, and the next most useful agents are ADM and VBL. Recent data from limited trials in patients with advanced bladder cancer suggest that combination chemotherapy regimens with these agents induces a high percentage of complete remissions (CR), an overall response rate between 50% and 70%, and a median response duration of longer than 6 months. Most active combination regimens are M-VAC (CDDP + MTX + ADM + VBL), CMV (CDDP + MTX + VBL), CM (CDDP + MTX) and CISCA (CDDP + ADM + cyclophosphamide). These combination regimens with M-VAC, CMV, CM and CISCA show a response rate of 57%, 57%, 46% and 46%, respectively. However, these drugs have a substantial toxicity and their combination has still been regarded as too hazardous. The attainment of CR in 20% to 40% of cases given these combination regimens has led to adjuvant and neoadjuvant chemotherapy.