Intravesical instillation therapy with anticancer drug is regarded as one of the ideal therapies against bladder tumors of superficial, multiple and relatively differentiated type.
There was a variety of factors which limit the anticancer agents suitable for intravesical instillation therapy. However Doxorubicin hydrochloride, a new anticancer drug isolated in 1967 from a mutant of streptomyces peucetius, was found to be effective for the treatment of superficial bladder cancer and it is considered the most suitable for this type of treatment, because fo the following characteristics: it is sensitive to transitional cell carcinoma, it is a dose-dependent agent, it has strong affinity to tissues, and its transfer from body cavities into the blood is negligible.
The local recurrence has been a matter of problem in the treatment of well-differentiated bladder tumor. Instillation of anticancer agents to the bladder has been tried to control bladder tumor itself as well as the local recurrence.
This drove us to study the effects of intravesical instillation of Doxorubicin hydrochloride to 49 patients with bladder tumor from view points of therapeutic effects on the tumor present and also prophylactic effects of preventing recurrence of tumor. And the results were analyzed and concluded as follows:
A. Therapeutic group
1. There were 20 males and 2 females.
The average age was 58.9 years, ranging from 39 to 77.
2. All these patients had transitional cell carcinoma: there were 5 of grade I, 13 of grade: II, and 4 of grade III tumors.
The disease was classified as stage A (TI) in 10 case3, stage BI (T2) in 9 cases, stage= B2 (T3) in 2 cases, and stage C (T3) in 1 case.
There were 17 cases of papillary-type tumors among them. Seven patients had solitary tumors and the remaining 15 cases had multiple lesions.
3. 60 mg of Doxorubicin hydrochloride dissolved in 30m1 of physiological saline was instilled through a Nelaton catheter transurethrally. The drug was retained for more than 2 hours and the treatment was repeated daily on 3 consecutive days followed by a 4-day interval, for 3 weeks.
4. The therapy was markedly effective in two cases and effective in 12 cases, while in 8 cases it was ineffective. The effectiveness rate was 63.6%.
5. Treatment of bladder tumors persisting after cessation of Doxorubicin hydrochloride was needed in most cases. TUC or TUR was performed in 14 cases including 1 in which the therapy was markedl}- effective, 9 in which it was effective, and 4 in which it was ineffective.
Segmental resection of bladder was performed in 6 cases, including 3 in the effective and 3 in the ineffective group. Most cases required surgery or radiation after instillation treatment; surgery was easily performed because the tumor size had been reduced and the loss of blood during the sugery was relatively small amount.
B. Prophylactic group
1. There were 24 males and 3 females. The average age was 61.1 years, ranging from 42 to 75.
2. All these patients had transitional cell carcinoma: there were 9 of grade I, 14 of grade JI, and 4 of grade III tumors. The disease was classified as stage A (TI) in 15 cases, stage B1 (T2) in 9 cases, and stage B2 (T3) in 3 cases. There were 22 cases of papillary-type tumors among them. Sixteen patients had solitary tumors and the remaing 11 cases had multiple lesions.
3. 30mg of Doxorubicin hydrochloride dissolved in 30ml physiological saline was instilled through a Nelaton catheter transurethrally. The drug was retained for more than 2 hours and the treatment was repeated daily on 2 consecutive days followed by a 5-day interval, for 4 weeks.
4. Follow up study at 3-month interval has shown excellent control of tumor recurrence with complete remissions for upto 24 months or more in 2 cases. The recurrence was not observed in 18 cases, but it occurred in 9 cases. The control group showed a recurrence rate of 83.3o while the group, in which prophylaxis performed with Doxorubicin hydochloride, showed a recurrence rate of 33.3% The median for recurrence in prophylactic group was 9.2 months and in control group, 6.55 months.
C. Side effects
No systemic side effects were noted in any of our cases. Local adverse effects such as bladder irritability were encountered in 5 cases of therapeutic group and 6 cases of prophylactic group.
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