SEQUENTIAL TRANSURETHRAL SURGERY, MULTIPLE-DRUG CHEMOTHERAPY AND RADIATION-THERAPY FOR INVASIVE BLADDER-CARCINOMA - INITIAL REPORT

Forty-seven patients with muscle-invasive bladder cancer (T2-T4, Nx, M O) were treated by transurethral resection, followed by 3-4 cycles of combination chemotherapy (methothrexate 30 mg/m2 on days 1, 14; cis-pl atinum 100 mg/m2 on day 2; vinblastine 3 mg/m2 on days 1, 14; repeated every 21 days), and external beam irradiation (64-66 Gy to the bladde r and 40 Gy to the pelvic lymphatics). Complete remission after trans urethral resection and chemotherapy was achieved in 24 out of 45 patie nts (53%). Cystectomy was performed in patients without complete respo nse to transurethral resection and chemotherapy. The therapy was compl eted as planned in 45/47 patients. After transurethral resection, chem otherapy, and radiation therapy, biopsy proven complete response was a chieved in 62% (28/45); Stage T2T3 in 67% (23/34), Stage T4 in 45% (5/ 11) of patients. Among 19 patients with positive biopsy findings after transurethral resection and chemotherapy, 14 underwent cystectomy. Af ter follow-up of 4-55 months (median 23 months) 75% (34/45) are alive, 68% (31/45) have had their bladders preserved, and 53% (24/45) are fr ee of the primary tumor. The actuarial survival of all 45 patients is 73%. Moderate nausea and vomiting during treatment were common; severe leukopenia and mucositis were observed in five patients. Late side ef fects such as miction disorders and diarrhea were predominately mild. Although the observation period has been too short to allow a definiti ve evaluation of treatment results, we feel both from the point of bla dder preservation and disease-free survival that the presented treatme nt approach is successful in a majority of T2T3 patients, whereas a la rge tumor size (T4) renders this treatment less effective.