Adriamycin (ADM), an antibiotic with anti-cancer activity, was used in the treatment of superficial bladder tumors in an attempt to facilitate the transurethral operative procedure. It was expected that small tumors would be completely destroyed. A total of 80 patients were included in this trial. Adriamycin was instilled into the bladder in the following dosages: 1, 000 mcg/ml (20 or 30 mg of ADM per 20 or 30 ml physiological saline), 1, 600 mcg/ml (50 mg of ADM per 30 ml of physiological saline), and 2, 000 mcg/ml (60 mg of ADM per 30 ml of physiological saline). The two groups (1, 000 mcg/ml and 1, 600 mcg/ml) were given this treatment for 3 consecutive days and underwent cystoscopic examinations about 2 weeks later. Those patiens who showed a good response to the therapy received a second course of the same treatment. In the third group (2, 000 mcg/ml), patients received Adriamycin for 3 consecutive days twice in 2 weeks: that is, a total of 6 times in all. Cystoscopy was performed in the 3rd week from the start of therapy. In this group, the course of 6 instillations was not repeated.
The effect of this therapy was evaluated by estimating the size of the tumor at cystoscopy. A decrease in size 90% or more was designated as markedly effective, 50% or more as effective, and less than 50% as ineffective. With the 1, 000 mcg/ml dose, the result was classified as markedly effective in 2 cases, effective in 3, and ineffective in 4 (55. 6%effective rate). At the 1, 600 mcg/ml level, the result was markedly effective in 7, effective in 11, and ineffective in 7 (72. 0% effective rate). While with 2, 000 mcg/ml it was markedly effective in 13, effective in 21, and ineffective in 12 (73. 9% effective rate). The results for the whole group comprised 22 markedly effective cases, 35 effective cases, and 23 ineffective cases (71. 3% effective rate).
The effect of the therapy was then examined in relation to the site and size of the tumor, together with the histopathological finding. There were no significant differences in the results for tumors at various sites, but the therapy gave good results for tumors occurring in the anterior wall or vesical neck, and even on thumb-maize or bigger tumors, which have been considered difficult to treat. In many of the cases with solitary tumors, the therapy proved ineffective, whereas in those with multiple tumors (whether primary or recurrent), the results were more often effective. High grade papillary tumor had the lowest rate of effectiveness (5 of 9 cases, 55. 6%), while 5 of 6 cases of non-papillary tumor had effective results. The results for all low grade tumors (72. 7%) was not considered to be significantly different from the results for all high grade tumors (64. 3%). These results indicate that the therapy can be expected to be effective in high grade tumors if the disease is at a low stage.
The systemic uptake of the drug was small. One case each of the systemic side-effects of depilation, thrombocytopenia and aggravation of the ECG pattern was seen. Of . the series, 24 patients (30%) complained of bladder irritation.
In view of these side-effects, 2, 000 mcg/ml (60 mg of ADM per 30 ml physiological saline) was considered an adequate concentration of Adriamycin for this treatment.
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