Outcome of postchemotherapy surgery after treatment with methotrexate, vinblastine, doxorubicin, and cisplatin in patients with unresectable or metastatic transitional cell carcinoma

Purpose: fire role of postchemotherapy surgery for patients with metastatic transitional tell carcinoma (TCC) is controversial. We retrospectively ana lysed our experience with patients who underwent postchemotherapy surgery a fter methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemothe rapy to assess an impact on long-term survival. Patients and Methods: This report is based on the retrospective analysis of 203 patients with unresectable primary tumors or metastatic TCC, previousl y reported in five trials of M-VAC chemotherapy, Fifty patients underwent p ostchemotherapy surgery for suspected or known residual disease. Characteri stics of patients selected for surgery, results of surgery, and the impact of surgery on survival were assessed. Results: In 17 patients, no viable tumor was found at postchemotherapy surg ery, pathologically confirming a complete response to chemotherapy. Three p atients herd unresectable residual TCC. In 30 patients, residual, viable TC C was completely resected, which resulted in a complete response to chemoth erapy plus surgery. Ten (33%) of these 30 patients remained alive at 5 year s, similar to results observed for patients who attained a complete respons e ta chemotherapy alone (41%). Analysis by baseline extent of disease sugge sted that patients with unresectable primary tumors or with metastases rest ricted to lymph node sites were most likely to survive for 5 years. Conclusion: postchemotherapy surgical resection of residual cancer may resu lt in 5-year disease-free survival in some patients who would otherwise suc cumb to disease. Optimal candidates include patients whose prechemotherapy sites of disease are restricted to the primary or lymph node sites and who have a major response to chemotherapy. (C) 1999 by American Society of Clin ical Oncology.