Neo-adjuvant chemotherapy and bladder preservation in locally advanced transitional cell carcinoma of the bladder.
BACKGROUND
The possibility of bladder preservation as well as the utility of neo-adjuvant chemotherapy for invasive bladder cancer are controversial issues. The purpose of this study was the evaluation of neo-adjuvant M-VAC chemotherapy and bladder preservation in patients with locally advanced transitional cell carcinoma of the bladder.


METHODS
Eighty-seven consecutive evaluable patients with T2-T4aNxM0 TCC of the bladder were treated with three cycles of neo-adjuvant M-VAC chemotherapy. After three cycles of M-VAC, 42 patients had TURB alone, 13 patients underwent partial cystectomy, and 32 patients were to undergo radical cystectomy.


RESULTS
Forty (51%) patients were T0 at the TURB following M-VAC. Thirty (71%) patients who had chemotherapy and TURB alone are alive; at a median follow-up of 54+ months (8(+)-109+). Twenty-four (57%) have maintained an intact bladder. Of 13 responding patients with monofocal lesions who underwent partial cystectomy, 8 patients (62%) are alive with a functioning bladder, at a median follow-up of 80+ months (16-107+ months). At a follow-up of 32 months (7-121+ months), 20 (63%) patients in the radical cystectomy group are alive. In patients who had downstaging to T0 or superficial disease, median follow-up is 55 months (10-121+ months) and five-year survival is 71%. Patients who failed to respond (T2 or greater after chemotherapy), at a median follow-up of 24 months (7-103+ months), had five-year survival of only 29%.


CONCLUSIONS
Bladder sparing in selected patients on the basis of response to neo-adjuvant chemotherapy is a feasible approach which must be confirmed in prospective randomized trials.
Sternberg
C N
CN
San Raffaele Scientific Institute, Rome, Italy. sternbc@roma.hsr.it
Pansadoro
V
V
Calabro
F
F
Marini
L
L
van Rijn
A
A
Carli
P D
PD
Giannarelli
D
D
Platania
A
A
Rossetti
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy / Q000379:methods; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D012720:Severity of Illness Index; 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