NEOADJUVANT CHEMOTHERAPY (MVAC) IN LOCALLY INVASIVE BLADDER-CANCER

In order to evaluate the efficacy of neoadjuvant chemotherapy in invas ive urothelial carcinoma of the bladder a retrospective analysis was p erformed, 54 patients without distant metastases (T2-T3b, N0-X, M0) re ceived 3 cycles of neoadjuvant chemotherapy according to the MVAC prot ocol (methotrexate, vinblastine, doxopubicin and cisplatin) after tran surethral resection (TUR) followed by cystectomy. 52 patients had prev iously undergone cystectomy immediately after TUR. Complete histopatho logical remission was observed in 9 patients (17.3%) after TUR and in 17 patients (31.5%) after TUR+MVAC. Neoadjuvant MVAC resulted, therefo re, in a 14% higher rate of complete remissions. The overall response to TUR was significantly improved by MVAC therapy. Downstaging by neoa djuvant chemotherapy was more readily achieved in initially low-stage tumours (T2: 44.4% and 30.8%, T3a: 47.1% and 19%, T3b: 5.3% and 5.5% i n patients receiving TUR+MVAC and TUR alone, respectively). Overall su rvival did not differ significantly between bath groups. Patients who were successfully downstaged to pT0 had a significantly better prognos is, and patients resistant to chemotherapy had the poorest prognosis, showing the shortest survival. In conclusion, histopathological respon se at cystectomy was improved by neoadjuvant MVAC chemotherapy after T UR and can be expected to be prognostically relevant in those patients who can be downstaged to T0, although overall survival failed to be s ignificantly increased in this relatively small patient sample. Copyri ght (C) 1996 Elsevier Science Ltd.