title: [Neoadjuvant chemotherapy and conservative surgery in invasive bladder cancer. Personal experience].
abstract: BACKGROUND
  To evacuate the efficacy of conservative treatment in invasive stage T2 bladder tumours by means of deep transurethral resection of the bladder (TURB) followed by three cycles of chemotherapy with methotrexate, vinblastin, adriamycin and cisplatin (M-VAC).
  
  
  METHODS
  Between September 1998 and March 2000, 5 patients have been submitted to transparietal TURB for endovesical neoplasia. Following histological confirmation of muscle involvement (stage T2), all patients were assigned to the M-VAC chemotherapy protocol after having established clinical stage with chest, abdominal and pelvic computed tomography (CT) and bone scintiscan. All cases were followed up for 18 months. Patients were evaluated by means of diagnostic cystoscopy, TURB and bladder mapping, 4 weeks after completing treatment.
  
  
  RESULTS
  Of these patients, 4 (80%) completed the treatment protocol. The patient who failed to complete the third cycle due to severe myelosuppression was submitted, two weeks later, to a lower dosage (<25%). Of these 5 patients 3 (60%) were tumour-free at the follow-up observation 4 weeks after chemotherapy, one patient (20%) still presented with involvement of the bladder wall, and one (20%) presented both with a superficial stage (Ta) and carcinoma in situ (Cis).
  
  
  CONCLUSIONS
  Deep TURB followed by three cycles of chemotherapy according to the M-VAC protocol, could be an effective alternative to conservative treatment of stage T2 bladder tumours.
authors.affiliation: Dipartimento di Urologia U. Bracci IV SS, Università degli Studi La Sapienza, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fischetti
authors.forename: F
authors.initials: F
authors.lastname: Barrese
authors.forename: S
authors.initials: S
authors.lastname: Cuzari
authors.forename: C
authors.initials: C
authors.lastname: Marino
authors.forename: S
authors.initials: S
authors.lastname: Mariani
authors.forename: P
authors.initials: P
authors.lastname: Morello
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*