[Infiltrating carcinoma of the bladder. Neo-adjuvant chemotherapy (2nd. part). Historic review and new treatment guidelines].
Analysis of 37 patients treated with neoadjuvant chemotherapy + radical cystectomy and bilateral lymphadenectomy. Follow-up of patients was until death and survival is between 43 and 68 months. There has been 26 deaths. Of these, 20 occurred within 24 months of therapy and only 6 after a two-year period. Five did not undergo surgery due to accelerated tumour progression during cytostatics administration. In another 5 cases, the idea of removing the bladder was discarded after significant loco-regional progression had been confirmed by laparotomy. 54% had involved lymph nodes. Metastasis was found in 57.3% and local relapse in 17.3%. The pre- operative chemotherapy investigated has not contributed to prolong the disease-free interval in the group of patients studied. After extended follow-up, the chemotherapy-treated group fared worse as compared with cystectomy alone and irradiation therapy (4,500 and 2,000 Rads.) followed by cystectomy. Presently, no patient should be deprived of the most effective therapy available: Surgery. Surgery should be a key step for the treatment of vesical infiltrant cancer. There are no resistant subpopulations to this option. Another question is to argue what sort of surgery should be used: TUR, radical o partial cystectomy. The ¿T¿ is useless to assess the efficacy of any therapeutical option adjuvant to surgery. Patients with pT2, pT3a tumours should be excluded from protocols designed to evaluate the performance of therapies added to surgery. All protocols investigating and adjuvant approach to radical cystectomy should include a control group with surgery alone.
Escudero Barrilero
A
A
Servicio de Urología, Hospital Ramón y Cajal, Madrid.
Fernández
E
E
Crespo
C
C
D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D006801:Humans; D009362:Neoplasm Metastasis; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery
Carcinoma infiltrante de vejiga. Quimioterapia neo-adyuvante (2a parte). Repaso historico y nuevas lineas de tratamiento.