[Neoadjuvant chemotherapy using methotrexate and cisplatin in locally advanced urothelial cancer of the bladder].
Thirty-one consecutive patients with clinically and histologically documented urothelial cancer of the urinary bladder of category T3-T4a, N0, M0 underwent a trial of neoadjuvant chemotherapy before radical cystectomy. All patients received 2 courses of methotrexate 300 mg/m2 day 1 followed by folinic acid rescue days 2 and 3 and cisplatin 100 mg/m2 day 4, q. 3 weeks. Only responders were to receive 2 further courses of chemotherapy. The protocol was violated in 5 cases and all did poorly. Of the remaining 26 patients, 19 (73%) had a partial or complete remission to neoadjuvant chemotherapy. The actuarial disease-free survival was very encouraging at 18 months (87% for responders versus 43% for the 7 non responders), but at 30 months the difference became minimal (60% versus 43%). Furthermore, all 3 responders who had refused radical cystectomy relapsed locally. Postoperative randomized trials are necessary to prove the advantage of neoadjuvant therapy with a long term survival and bladder preservation.
Pizzocaro
G
G
Istituto Nazionale Tumori Milano.
Piva
L
L
Minervini
G
G
Dormia
E
E
Maggioni
A
A
Mandressi
A
A
Pisani
E
E
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015653:Cystectomy; D004341:Drug Evaluation; D004848:Epithelium; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
D002945:Cisplatin; D008727:Methotrexate
Chemioterapia neoadiuvante con methotrexate e cisplatino negli uroteliomi vescicali localmente avanzati.