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Between April 2004 and August 2005, we used docetaxel in combination with prednisolone to treat 14 patients with hormone-refractory prostate cancer (HRPC). Docetaxel was administered at a dose of 70 mg/m2 once every 21 days and oral prednisolone 5 mg was administered twice daily concurrently on days 1-21. The treatment was continued until disease progression or unacceptable adverse events occurred. Prostate specific antigen (PSA) was used as a tumor marker. PSA response was defined as a reduction from baseline of at least 50% that was maintained for 4 weeks. Five patients had measurable soft tissue lesions, which were nodal metastases in 4 and liver metastasis in 1. The median follow-up was 8.4 months. During follow-up, 5 patients died. The median treatment cycle was 7 cycles. Manifestations of hematologic toxicity included 11 patients (78%) with grade 3/4 neutropenia and only I with febrile neutropenia. Two patients with gastric hemorrhage and febrile neutropenia needed hospitalization. During follow-up, 8 patients (57%) achieved a PSA reduction from baseline of at least 50%. Three patients with nodal metastases and 1 patient with liver metastasis had partial response. Combined docetaxel and prednisolone was shown to be effective and feasible in Japanese patients., 【目的】ホルモン抵抗性前立腺癌に対しドセタキセル+プレドニゾロン療法を行い, その有用性を検討した。【対象・方法】対象は2004年4月以降に再燃前立腺癌と診断された14例。観察期間は8.4ヵ月, 7コース(5.5コース)施行した。プレドニゾロン(10mg/日)連日投与を併用しドセタキセル70mg/m2を21日毎に点滴投与を繰り返した。全例, 転移巣を有しており, 測定可能病変は4例がリンパ節, 1例は肝臓であった。原則として外来通院治療とした。【結果】14例中8例(57%)で腫瘍マーカーが50%以上減少した。測定可能病変とでは肝臓の1例とリンパ節の2例がPRとなった。鎮痛剤を使用していた7例中4例が減量・中止可能であった。貧血が2例で改善し, 1例で発熱も改善した。血液有害事象では好中球減少ではgrade3/4が11例であった。PDのため4例, 高度の皮膚粘膜病変のため1例が中止し, ステロイドによる出血性胃潰瘍, 帯状疱疹のため1例ずつが休薬となった。発熱性好中球減少のため1例が入院を要した。【結語】好中球減少症を高頻度に認めるが外来治療が可能であり, また抗腫瘍効果, 疼痛の改善においても有用と思われた。(著者抄録)

A total of 42 patients with hormone-refractory prostate cancer received E-E therapy. Oral estramustine phosphate (EMP) was administered twice daily for a total daily dose of 560 mg every day and oral etoposide (E-E therapy, 50 mg/body/day) was given on days 1-21 and stopped on days 22-35. Treatment was continued until the disease progression was confirmed radiographically or PSA had increased from base line of at least 25%. The median follow-up period after E-E therapy was 77.4 months (range : 12.5 to 122.3). Nineteen patients (43%) achieved a PSA decrease of 50% or greater. The median survival time of the patients who had a decrease of 50% or greater in the PSA value (PSA responder) was 29.3 months and the patients who did not (PSA non-responder) was 14.1 months (p = 0.01). There were no significant differences between PSA responders and non-responders when taking into account variables. Excluding those patients with only PSA elevation, the survival time was 14.9 months with no significant difference between PSA responders and non-responders. The toxicities (grade 3 or more) were identified as anemia, leukocytopenia thrombocytopenia, cardiovascular events, and gastrointestinal and hepatic disorders, which occurred in 0, 5, 2, 2, 14, and 2% of the patients, respectively. E-E therapy was considered to be an active oral regimen and well-tolerated for outpatients with hormone-refractory prostate cancer in Japanese patients., 【目的】日本人における再燃前立腺癌に対する経口リン酸エストラムスチン(EMP), エトポシド(VP-16)併用療法(EE療法)の効果および副作用について検討した。【方法】1995年以降, EE療法が施行された再燃前立腺癌患者42例が対象。EMP:560mgを連日投与, VP-16:50mgを21日投与し14日休薬を1サイクルとした。PSAが50%以上低下したものをresponderとし, 治療は画像上の増悪またはPSAが基準値より25%を認めるまで継続した。【結果】観察期間は77.4ヵ月。19例がresponderであった。42例の生存中央値は20.5ヵ月でありresponderでは29.3ヵ月, non-responderで14.1ヵ月(p=0.008)であった。群間でresponseに寄与する因子は存在しなかった。Grade 3以上の副作用は白血球減少(5%)が2例, 血小板減少(2%)が1例, 悪心が6例(14%), 肝機能障害が1例(2%), 深部静脈血栓症(2%)が1例に認めた。【結語】EE療法は抗腫瘍効果もあり, 副作用も容認でき日本人にも施行可能であった。(著者抄録)

根治的膀胱全摘除術や動注化学放射線療法が施行できない浸潤性膀胱癌に対して, 白金製剤を用いた全身化学放射線併用療法を行い, 8例中6例のCRが得られ, 有害事象に関しても寛容であった, Eight patients with locally advanced bladder cancer who were not candidates for radical cystectomy or concurrent intra-arterial chemotherapy and radiotherapy were treated with combined platinum-based chemotherapy and radiation therapy. Six of the eight patients (75%) achieved a clinical complete response (CR). The effect of therapy in four patients whose histopathological responses were evaluated was effect grade 3. One of the eight patients died of treatment-related myelosuppression. The other two patients died of intercurrent disease, while the remaining five patients are alive with preservation of a functional bladder. The 2-year overall survival rate was 87.5%. Adverse events due to chemotherapy were mainly bone marrow suppression. Those caused by radiation therapy were rectal irritability. We considered concurrent platinum-based chemotherapy and radiotherapy useful for the treatment of locally advanced bladder cancer.

症例1(68歳男)は上咽頭癌の既往があり, 胃癌精査中に右腎下極に径20mm, 左腎中外側部に径20mmの腎癌を発見され, 胃部分切除と両側腎部分切除を行った.術後43ヵ月目に肺炎で死亡し, 腎癌の再発はなかった.症例2(53歳女)は右腎上極に径80mm, 左腎上極に径13mmの腎癌があり, 右腎摘出と左腎部分切除を行った.48ヵ月後迄は再発はない.症例3(48歳男)は右腎上極に径70mmと3個の径10mm, 左腎に4個の径10mmの腎癌があり, 右腎摘出と, 左腎部分切除を行った.23ヵ月後迄は再発はない, We report here three cases of bilateral synchronous renal cell carcinoma. One of the 3 patients underwent bilateral partial nephrectomy, while the other 2 underwent combined partial nephrectomy and radical nephrectomy. All patients received adjuvant therapy of interferon-alpha and tegafur uracil. In the management of synchronous bilateral renal cell carcinoma, we discussed the selection of surgical procedure for primary lesions, i.e., based on the renal function of both sides, and the necessity of adjuvant therapy in such cases.

浸潤性膀胱癌に対する放射線併用動注化学療法のretrospective studyの長期成績及び現在施行中のprospective studyについて報告した.この治療により膀胱温存が可能な症例や治療法を考察した.前立腺癌に対する放射線併用動注化学療法の適応や治療結果も報告した, Forty-five patients with muscle-invasive bladder cancer treated with intra-arterial doxorubicin chemotherapy plus low-dose radiotherapy between September 1979 and March 1990 were retrospectively studied. Twenty-eight (62%) patients achieved a complete response (CR) and in all of them, a functional bladder could be preserved. The 10-year cause-specific survival rate of patients with CR was 95.5%, but that of patients not achieving a CR was 39%. These results demonstrate that in patients who achieve a CR with this treatment, we may be able to preserve a functional bladder. In a prospective study, we designed a new intra-arterial chemotherapy regimen in order to achieve a higher degree of effectiveness and to preserve a functional bladder. Twenty-three patients were treated with concurrent pirarubicin/cisplatin intra-arterial chemotherapy and radiotherapy after complete transurethral resection. Twenty-one (91%) patients achieved CR. One of these patients had relapse with lung metastases and was treated surgically. Two patients who did not achieve a CR died of cancer, and 21 patients are alive with preservation of functional bladder. For treatment of prostate cancer, we now administer only adjuvant intra-arterial chemotherapy plus irradiation for patients after radical prostatectomy.

A 57-year-old man was admitted with the chief complaint of macrohematuria. Digital rectal examination showed a slightly enlarged, irregular prostate with stony consistency. Serum levels of prostate specific antigen (PSA), neuron-specific enolase (NSE) and progastrin-releasing peptide (ProGRP) were elevated. Transurethral resection (TUR)-biopsy of the prostate revealed small cell carcinoma with poorly differentiated adenocarcinoma. Various radiological examinations revealed metastases to pelvic lymph nodes and liver. He was treated with chemoendocrine therapy consisting of cisplatin, etoposide, flutamide and luleinizing hormone-releasing hormone (LH-RH) agonist. The primary tumor and metastatic lesion decreased and serum PSA, NSE and ProGRP levels were decreased to normal ranges after 5 cycles of chemotherapy. After the 5-cycle chemotherapy, TUR-biopsy proved viable tumor cells. During the additional chemotherapy, tumor markers increased and 4 months later liver metastasis progressed. He died 13 months after diagnosis of small cell carcinoma of the prostate.

前立腺全摘除術を施行した18症例を対象とした.1)全例予定量の800mlの貯血が可能であり, 副作用は認めなかった. 2)貧血からの回復も良好で, Hb低下量, 術前Hb増加量及びARRの有効率はそれぞれ72.2%, 72.2%, 66.7%であった. 3)18例中16例(88.9%)は自己血以外の同種血輸血は必要としなかった, The usefulness of recombinant human erythropoietin (rHuEPO) on autologous blood transfusion was investigated in 18 patients undergoing radical prostatectomy (mean age 67.4 years). A total of 800 ml blood was deposited by two donations of 400 ml each, concomitant with subcutaneous administration of 24, 000 U rHuEPO at each donation. All patients completed two successive donations with no adverse effects. The mean hemoglobin concentration was 13.7 g/dl before the donation and 13.0 g/dl on the day of operation. The decrease in hemoglobin was effectively prevented in 12 patients (66.7%) with rHuEPO, when compared with the predicted decrease in the absence of recovery from anemia. During radical prostatectomy, no homologous blood transfusion was required in 16 of 18 patients (88.9%). In conclusion, predeposit autologous blood transfusion with rHuEPO is useful for diminishing the risks associated with homologous blood transfusions.

From September 2003 to December 2005, 188 patients who visited our hospital and allied institutions for the purpose of prostate brachytherapy were administrated hormonal therapy for volume reductions before brachytherapy. The pretreatment and posttreatment of prostate volume using a transrectal ultrasound volumetric study and the types and duration of hormonal therapy were analyzed. We administered 91 patients with Luteinizing hormone-releasing hormone (LH-RH) agonist, 49 patients with anti-androgen (bicaltamide/flutamide), and 48 patients with maximum androgen blockade (MAB). The duration of the hormonal therapy was 1-3 months for 49 patients, 4-6 months for 59 patients, 7-9 months for 40 patients, 10-12 months for 32 patients, and over 13 months for 8 patients. Before the initiation of hormonal therapy, the mean prostate volume was 35.12 ml (11.04-78.71 ml), and the average of prostate volume before and after hormonal therapy was 36.79 ml and 24.79 ml, respectively (a 32.4% reduction). The prostate volume reduction rate was 32.0% for the LH-RH agonist only, 18.1% for the anti-androgen only and 41.2% for the MAB. No statistically significant difference was observed for the duration of hormonal therapy between 3 groups. A three-month course of the neoadjuvant LH-RH agonist indicated a sufficient volume reduction effectiveness for a large prostate volume.

発症より10年後腎クリーゼにて急性腎不全を起こした進行性全身性硬化症の1例を経験した.急激な腎機能低下, コントロール不良な高血圧, 大量の消化管出血を認め, 治療開始約1カ月後死亡した.本症例では入院時すでにDICと腎不全が高度であったこと, 消化管出血によりアンギオテンシン変換酵素阻害剤であるenalaprilが経口投与できなかったことが予後不良であった原因と考えられた.剖検時の腎の光顕所見で動脈内膜の肥厚と軽度の腎硬化像が認められた., We report a case of progressive systemic sclerosis with scleroderma renal crisis 10 years after onset. The patient (female) had progressive renal dysfunction, hypertension which was difficult to control, and massive gastrointestinal bleeding. An angiotensin converting enzyme inhibitor (enalapril) could not control her hypertension. Only intravenous nicardipine had a slight effect on her hypertension. Hemodialysis and plasma exchange, did not reverse the renal crisis, and the patient died. Microscopic examination of her kidney showed thickening of the capillary walls and mild nephrosclerosis.