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.