5-YEAR RESULTS OF NEOADJUVANT CISPLATIN, METHOTREXATE AND VINBLASTINECHEMOTHERAPY PLUS RADICAL CYSTECTOMY IN LOCALLY ADVANCED BLADDER-CANCER

Neoadjuvant systemic cisplatin, methotrexate and vinblastine chemother apy has been used in the treatment of 69 patients with advanced bladde r cancer (stages T2-T4 N+/NO MO). Sixty patients were evaluable for re sponse at a median follow-up of 48 months. Preoperative resection of t he tumor was purposely avoided in order to keep a marker lesion. After planned radical cystectomy, pathological complete responses (pCRs) an d partial responses (pPRs) were documented in 5 (8.3%) and 29 cases (4 3.4%), respectively. These patients had a 5-year disease-free survival rate of 80%, which was statistically superior (p = 0.0013) to 35% for the remaining nonresponding patients. One patient (20%) with a pCR di ed of systemic disease after 14 months, while the remaining 4 patients (80%) are alive and free of disease after a median followup of 57 mon ths. A higher percentage of pCRs and pPRs was observed in the group of patients with stage T3b-T4 tumor (pCR 11%, pPR 63%) in contrast to th e patients with stage T2-T3a disease (pCR 4.5%, pPR 45.5%), even if no significant difference in the 5-year survival rate was observed betwe en the 2 groups. Patients with a G2 tumor before chemotherapy survived longer (5-year survival rate of 78%) than those with G3 disease (5-ye ar survival rate of 61%), but no significant difference was achieved.