[Neo-adjuvant M-VAC in the treatment of infiltrating bladder tumors].
Between June 1987 and December 1990, systemic chemotherapy following an M-VAC protocol was applied to 38 patients with infiltrant vesical carcinoma (T2-T4). Eight of them (21.05%) were excluded for treatment response evaluation (four due to withdrawal and four to severe toxicity, one of whom died). Of the 30 evaluable patients, 63.3% (19 patients) showed complete response (pT0) after three complete courses of chemotherapy. Of this group, 11 have relapsed within an average interval of 21 +/- 18 months, 5 cases infiltrant (three with cystectomy) and 6 superficial. Mean survival of these 11 patients was 32.9 +/- 16.3 months. Of those showing complete response, 4 (13.3%) developed systemic tumoral progression in an average time of 12.5 +/- 4.2 months, to the point of being impossible to perform any kind of rescue surgery, with a mean survival of 13 +/- 4.5 months. In five patients, 16.6% of sample, stage at post-MVAC biopsy was lower than the initial one, requiring a new TUR (survival, 25.2 +/- -- months). Of these, 4 relapsed with 3 requiring rescue surgery. The remaining 6 patients in the sample (20%) showed no response to chemotherapy, and radical surgery was indicated which was only possible in three of them (survival, 14 +/- 6.8 months). The poor results of this series question the effectiveness of the MVAC protocol for chemotherapy in infiltrant vesical tumours. Only in low stages (T2) good results are observed, while in other cases it delays radical surgery, presumably curative if performed timely.
García Reboll
L
L
Servicio de Urología, Hospital Universitario La Fe, Valencia.
Vera Donoso
C D
CD
Ruíz Cerdá
J L
JL
Pontones Moreno
J L
JL
Martínez Jabaloyas
J M
JM
Jiménez Cruz
J F
JF
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012074:Remission Induction; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D014747:Vinblastine / Q000008:administration & dosage
D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate
M-VAC neo-adyuvante en el tratamiento de los tumores vesicales infiltrantes.