[Infiltrating transitional carcinoma of the bladder. (1st part). Preoperative or neoadjuvant chemotherapy. Our experience with 38 patients followed-up for a prolonged period].
Analysis of the evolution of 37 patients treated with neoadjuvant chemotherapy + radical cystectomy and bilateral lymphadenectomy. Patients were followed until death, and survivors between 43 and 68 months. Twenty-six patients died. Twenty of them within 24 months after treatment and 6 after 2 years. Five did not undergo surgery due to fast tumour progression during the interval scheduled for cytostatics administration. Bladder removal was rejected in 5 cases after a significant loco-regional progression was shown by laparotomy. Initially, bladder was preserved in 12 patients after TUR + chemotherapy, and in 8 patients when cCR was observed: 1 died due to a disease unrelated cause. 1 was lost after 16 months with no evidence of vesical cancer or metastasis. 3 presented distant dissemination. 3 are alive and have no evidence of tumour. 1 pCR died of metastasis. 1 cPR required radical cystectomy and died of metastasis. Of the 2 cases defined as sCR, one had to undergo radical cystectomy and remains disease-free while the other one died of metastasis. Radical cystectomy was performed in 15 cases. Three remain tumour-free, 2 were lost. to follow-up and 10 died (3 for disease-unrelated causes and 7 as a consequence of their condition). Nodes affectation were present in 54%. Metastasis was found in 57.3% and 17.3% had local relapse. The pre-operative chemotherapy regime examined has not contributed to prolong the metastasis-free interval in the group of patients studied.
Escudero Barrilero
A
A
Servicio de Urología, Hospital Ramón y Cajal, Madrid.
Fernández
E
E
Crespo
C
C
D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011300:Preoperative Care; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery