J. Jpn. Stomatol. Soc. 39(1) : , January, 1990 Clinical and histopathological studies of combination therapy with Cisplatin and Peplomycin (PP t
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1 J. Jpn. Stomatol. Soc. 39(1) : , January, 1990 Clinical and histopathological studies of combination therapy with Cisplatin and Peplomycin (PP therapy) for the carcinoma of the tongue Iwai TOHNAI, Hideki MIZUTANI, Minoru UEDA, Yusuke TAKEUCHI, Yasuyuki GOTOH, Tetsuo SHINODA, Yasushi HAYASHI, Makoto YAMBE and Toshio KANEDA Abstract : In the present study we investigated the clinical and histopathological effects of PP therapy by combined use of Cisplatin (CDDP) and Peplomycin (PEP) for 22 cases of the carcinoma of the tongue. The results were as follows ; 1. The clinical response rate was 81.8 % (including 2 CR, 16PR, 3MR and one NC). 2. The histopathological response rate was 50.0 % (including 2 Gradeo EI, 9 Grade II a, 4 Grade II b, 6 Grade III and one Grade IV). 3. The clinical effects did not always agree with the histopathological effects. There were discrepancies between clinical and histopathological effects, especially in PR determined by clinical findings. 4. From the view points of the WHO Grade, the histopathological effects by Obosi Shimosato classification results that there was effectiveness among 11 cases of 18 of Grade I (64.7 %), and none of Grade II and III. 5. From the view points of the mode of invasion, the histopathological effects results that there was effectiveness among 7 cases of 8 of 1, 2 type (87.5 %), 3 cases of 8 of 3 type (37.5 %), one case of 4 of 4C type (25.0 %) and none of 4D type. Department of Oral Surgery, Nagoya University School of Medicine (Chief : Prof. Toshio KANEDA) 65, Tsurumai-cho, Showa-ku, Nagoya, 466. Japan
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4 178 藤 内 水 谷,他 表7 Histological of response by 口科誌 っ た WHO mode invaslon Grade I症 例18例 組 織 効 果 のGrade II b以 1990年 の 中 で,病 理 上 の 有 効 例 は11例 で あ り,有 効 率 は,64.7%で あ っ た 逆 にWHO Grade 星 下 里 で の 病 理 組 II,III症 例 で は,大 織 効 果 のGrade II b以 上 の 有 効 例 は1例 も認 め な か った 表7は 病 理 組 織 効 果 を 浸 潤 様 式(山 分 類14))別 に み た もの で あ る 本 症 例 の中 で浸 潤 様 式 の1,2型 例,4D型2例 の 病 理 組 織 効 果 は,Grade 3例(有 IIb以 効 率37.5%),4C型 上 の 有 効 例 は7例(有 で の 有 効 例 は1例(有 本 小 浜 は8例,3型8例,4C型4 で あ っ た 浸 潤 様 式 の1,2型 効 率87.5%)と 効 率25.0%)で 高 か っ た 3型 あ っ た し か し4D型 での 有 効 例 で は有 効 例 は み られ な か った 次 に 代 表 的 な 症 例 を 供 覧 す る が,ま 写 真1は57歳,男 性,T2NOMO症 例 の 初 診 生 検 時 の 病 理 組 織 像 で あ る cancer れ 比 較 的 よ く分 化 して い るWHO分 2型 で あ る 写 真2は,PP療 下 に はfibrosisが pearlも 潤様式 ー ス施 行 後 の同 症 例 の病 理 組 織 像 で あ る 上 皮 生 検 時 の 病 理 組 織 像 で あ る が,高 IVで あ る 写 真3は,異 分 化 型 のWHO分 潤 様 式 は 境 界 線 が 不 明 瞭 で 大 小 の 腫 瘍 胞 巣 が 散 在 し て お り,3型 類1型 で で あ る 写 真4はPP療 ー ス施 行 後 の 同 症例 の 病 理 組 織 像 で ある 変 性 壊 死 に 陥 った 腫 瘍 細 胞 塊 の 周 囲 を 異 物 巨 細 胞 が 取 囲 ん で お り(写 真 の 矢 印),viableな 腫 瘍 細 胞 は み られ ず 大 星 下 里 分 類 の IIIで あ る 写 真1 多 くみ ら で あ る 浸 潤 様 式 は 境 界 線 が や や 乱 れ を 認 め,浸 法 を動 注 法 に よ り2コ 性,T1NOMO)の 法 を 動 注 法 に よ り2コ Grade 類1型 存 在 し筋 肉 内 ま で 及 ん で お り,大 星 下 里 分 類 のGrade な る 症 例(67歳,男 あ り,浸 ず 有効 例 に つ い て示 す 写 真2
5 39巻 舌 癌 のPP療 1号 写 真3 写 真5 規 則 な 索 状,胞 写 真6 男 性,T4NIMO症 在 性 に腫 瘍 細 胞 が 浸 潤 し て お り,や 例 の生 検 時 の病 理 組 織 像 で あ る 小 や 分 化 の 乏 し い 像 を示 し,WHO分 類 II型 で あ る 浸 潤 様 式 に つ い て は 境 界 線 が 不 明 瞭 で 腫 瘍 細 胞 は び 慢 性 に 浸 潤 して お り,4D型 で あ る 写 真6はPP療 巣 状,散 写 真4 次 に 無 効 例 に つ い て示 す 写 真5は69歳 179 法 の臨 床 効 果 と病 理 組 織 効果 法 を 動 注 法 に よ り2コ ー ス施 行 後 の 病 理 組 織 像 で あ る が,上 で 浸 潤 性 に シ ー ト状 充 実 性 胞 巣 を 形 成 しつ つ 増 殖 す る腫 瘍 細 胞 を 認 め,大 星.下 皮 側 か ら筋 層 に ま 里 分 類Grade I型 を示 して い る 考 頭 頸 部 領 域 癌 で のCDDPの 使 用 はLippmanら15)が 察 初 め て 報 告 し,Wittesら16)に よ っ て そ の有
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