PRIMARY CISPLATIN, METHOTREXATE AND VINBLASTINE AIMING AT BLADDER PRESERVATION IN INVASIVE BLADDER-CANCER - MULTIVARIATE-ANALYSIS ON PROGNOSTIC FACTORS

Purpose: Although radical cystectomy is the standard therapy for invas ive bladder cancer, cisplatin based multi-drug chemotherapy has proved to be effective for advanced transitional cell urothelial carcinoma. The potential for bladder preservation with neoadjuvant chemotherapy i s currently under investigation.Materials and Methods: A phase 2 proto col is presented for conservative treatment of muscle invasive transit ional cell carcinoma of the bladder consisting of primary cisplatin, m ethotrexate and vinblastine chemotherapy followed by reevaluation for bladder sparing surgery and surveillance, A total of 61 patients compl eted the protocol with a mean followup of 41.4 months. Results: Initia l complete response to chemotherapy associated with tumor stage, size and configuration was noted in 20 patients (33%). Bladder preservation , intended only for the complete response group, was achieved in 16 pa tients (26%) but only 11 (18%) were alive with the bladder intact at s tudy closure. Disease-free 5-year survival rate was 47% (95% confidenc e interval 65 to 26%). Tumor stage (p = 0.0007), size (p = 0.0003), re sponse to chemotherapy (p = 0.002), patient age (p = 0.039) and tumor grade (p = 0.048) influenced survival. Multivariate analysis revealed response to chemotherapy (beta = 0.988, p = 0.034) and tumor size (bet a = 0.978, p = 0.042) to be the only independent predictors. Conclusio ns: Induction of cisplatin, methotrexate and vinblastine chemotherapy is helpful in identifying patients with a greater chance for survival among those with locally advanced bladder cancer. However, a bladder p reservation strategy based on this therapy is only of limited success.