Radical transurethral resection and chemotherapy in the treatment of muscle-invasive bladder cancer: a long-term follow-up

Objective To evaluate the treatment of patients with muscle-invasive bladde r cancer (T2-T-4a) by radical transurethral resection (TUR) and cisplatin-m ethotrexate systemic chemotherapy. Patients and methods Fifty patients with transitional cell carcinoma (TCC) of the bladder (nine T2, 36 T3 and eve T4a) were treated by 'complete' TUR of the bladder tumour followed by 2-6 cycles of cisplatin (70 mg/m(2)) and methotrexate (40mg/m(2)) chemotherapy. The median (range) tumour size was 3 (1-7 cm). In sh patients, attempted TUR at the dome of the bladder led to intraperitoneal perforation; the tumour was excised by partial cystectomy i n these patients. The latest follow-up results from 57 patients treated by radical TUR and methotrexate alone, reported previously, are included. Results At the first evaluation cystoscopy immediately after completing che motherapy. 38 patients were tumour-free, eight had persistent muscle-invasi ve TCC and four had Ta, T1 + CIS disease. With an overall median follow-up of 47 months, 10 additional patients relapsed with muscle-invasive carcinom a in the bladder after a median interval of 15.6 months: three patients dev eloped Ta, T1 tumours, three Ta, T1 + CIS, and six CIS only, Six of the 10 recurrent invasive tumours were at the same site, but four were at a differ ent site in the bladder. Although during followup 12 patients developed sup erficial recurrence that required endoscopic treatment, the bladder was pre served (free of muscle-invasive cancer) in 37 of 50 patients. In 30 of thes e 37, this was achieved with no need for salvage radiotherapy or cystectomy . Sh patients died from metastatic TCC with no tumour in the bladder, Conclusion In this selected group of patients, muscle-invasive bladder canc er was controlled by TUR and systemic chemotherapy, preserving normal bladd er function in 60% of patients without apparently comprising overall surviv al.