title: [Neoadjuvant chemotherapy (M-VAC) in invasive cancer of the bladder. Our experience].
abstract: Thirty-three patients with locally advanced T2-4NxM0 muscle infiltrating bladder carcinoma were treated with M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) following TUR. Twenty-eight patients were evaluable since 4 had been receiving the foregoing treatment and 1 was being reevaluated after having undergone a partial cystectomy procedure prior to the chemotherapeutic regimen. Eighteen patients underwent radical cystectomy after neoadjuvant chemotherapy, 2 bladders could not be resected, 2 patients refused the procedure and the remaining 6 patients had a functioning bladder. Of the 28 patients, 46.42% (pCR) were pT0 (including the 6 patients with a functioning bladder, and 10.71% (pPR) were down-staged. This represents a pGR of 57.13%. Four of the 18 patients who underwent cystectomy had a higher pathologic stage evidenced by the surgical specimen than the initial finding at TUR indicating that 22.22% had been understaged. Noninvasive diagnostic methods (TUR, cytology, ultrasound, CT...) could not demonstrate the presence of tumor in those patients with preserved bladder. The cRC is similar (46.42%) and the cRP was 7.14%, giving a total cRG of 53.56%. With a mean follow-up of 13.63 months (range 5-36+), 54.54% are alive and disease-free, including the 6 patients with preserved bladder, and 21.21% are alive with locoregional recurrence or distant metastasis. Currently the mortality rate is 9.09%. The correlation of the data gleaned from the clinical response and that of the pathological condition, the possible understaging of the preserved bladders and the outcome in a series with a very short follow-up have as yet to be elucidated.
authors.affiliation: Servicio de Urología, Hospital Miguel Servet, Zaragoza, España.
authors.forename: C
authors.initials: C
authors.lastname: González Enguita
authors.forename: C
authors.initials: C
authors.lastname: Caro Cebrián
authors.forename: A
authors.initials: A
authors.lastname: Roncalés Badal
authors.forename: M J
authors.initials: MJ
authors.lastname: Gil Sanz
authors.forename: J
authors.initials: J
authors.lastname: Martínez Bengoechea
authors.forename: L A
authors.initials: LA
authors.lastname: Rioja Sanz
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015653:Cystectomy; D004317:Doxorubicin / Q000008:administration & dosage; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012074:Remission Induction; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate
vernacular_title: Quimioterapia neoadyuvante (M-VAC) en el cáncer invasivo de vejiga. Nuestra experiencia.