HIGH-INCIDENCE OF BRAIN METASTASES IN PATIENTS TREATED WITH AN M-VAC REGIMEN FOR ADVANCED BLADDER-CANCER

Objective: We report on central nervous system metastases;from urothel ial bladder carcinoma in patients treated with M-VAC chemotherapy. Met hods: 50 patients with advanced transitional cell carcinoma of the bla dder were treated with the M-VAC regimen at the Hospital Cochin (Paris , France) between December 1989 and February 1995. Brain relapses were diagnosed by CT scanning. Results: We observed a surprising increase in the number of central nervous system relapses (8/50) in patients tr eated consecutively at the same institution. The mean time to metastat ic recurrence in the brain fi om the initiation of first chemotherapy was 21 months (range 7-38). Six patients had single and 2 patients had multiple central nervous system metastases. Treatment consisted of ra diotherapy alone (n = 5) of both surgery and radiotherapy (n = 3). Med ian survival time from the appearance of cerebral metastases was 3 mon ths (range 1-10). Conclusion: The prolonged duration of remissions whi ch are achieved following M-VAC chemotherapy may explain the greater l ikelihood of the detection of cerebral involvement.