High incidence of brain metastases in patients treated with an M-VAC regimen for advanced bladder cancer.
OBJECTIVE
We report on central nervous system metastases from urothelial bladder carcinoma in patients treated with M-VAC chemotherapy.


METHODS
50 patients with advanced transitional cell carcinoma of the bladder were treated with the M-VAC regimen at the Hôpital Cochin (Paris, France) between December 1989 and February 1995. Brain relapses were diagnosed by CT scanning.


RESULTS
We observed a surprising increase in the number of central nervous system relapses (8/50) in patients treated consecutively at the same institution. The mean time to metastatic recurrence in the brain from the initiation of first chemotherapy was 21 months (range 7-38). Six patients had single and 2 patients had multiple central nervous system metastases. Treatment consisted of radiotherapy alone (n = 5) or both surgery and radiotherapy (n = 3). Median survival time from the appearance of cerebral metastases was 3 months (range 1-10).


CONCLUSIONS
The prolonged duration of remissions which are achieved following M-VAC chemotherapy may explain the greater likelihood of the detection of cerebral involvement.
Dhote
R
R
Service of Internal Medicine, Hôpital Cochin, Paris, France.
Beuzeboc
P
P
Thiounn
N
N
Flam
T
T
Zerbib
M
M
Christoforov
B
B
Debré
B
B
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D002945:Cisplatin / Q000008:administration & dosage / Q000494:pharmacology; D004317:Doxorubicin / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D014747:Vinblastine / Q000008:administration & dosage / Q000494:pharmacology
D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate