A case of regionally metastatic pure squamous cell carcinoma of the urinary bladder successfully treated with radical chemoradiotherapy

46歳男.頻尿, 肉眼的血尿を自覚し, 症状が徐々に増悪し排尿痛も出現した.CRP軽度上昇以外の血液・生化学的異常は認めなかった, が膀胱鏡で非乳頭状広基性腫瘍を認めた.骨盤部MRIでは腫瘍は膀胱内腔の大部分を占め, 膀胱周囲脂肪組織および前立腺への浸潤が疑われた.また, 左右内腸骨領域にリンパ節を多数認めたが胸腹部CTおよび骨シンチでは他臓器への転移は認めなかった.経尿道的切除術による生検を実施し膀胱扁平上皮癌, 臨床病期T3bN2M0と診断し全骨盤の外照射を施行した.動脈内注入化学療法を2コースにpepleomycin sulfate(PEP)の全身投与を併用した.MVAC regimenによる全身化学療法を2コース追加しリンパ節も60%縮小しPRとなった.放射線性膀胱炎による血尿, 膀胱刺激症状が強いため, 膀胱全摘除術, リンパ節郭清術, 回腸導管造設術を行った
We report a case of regionally metastatic pure squamous cell carcinoma of the urinary bladder successfully treated with combined radiation and chemotherapy in a 46-year-old man. Clinical staging was T3bN2M0. The patient received 50 Gy external radiation combined with intraarterial and systemic chemotherapy. Pathological complete response was found both in bladder and regional lymph nodes when he underwent radical cystectomy and lymph node dissection. The patient has been alive without evidence of disease for two years postoperatively.