Neo-adjuvant chemotherapy and bladder preservation in locally advanced transitional cell carcinoma of the bladder

Background: The possibility of bladder preservation as well as the utility of neo-adjuvant chemotherapy for invasive bladder cancer are controversial issues. The purpose of this study was the evaluation of neo-adjuvant M-VAC chemotherapy and bladder preservation in patients with locally advanced tra nsitional cell carcinoma of the bladder. Patients and methods: Eighty-seven consecutive evaluable patients with T-2- T(4)aN(x)M(0) TCC of the bladder were treated with three cycles of neo-adju vant M-VAC chemotherapy. After three cycles of M-VAC, 42 patients had TURB alone, 13 patients underwent partial cystectomy, and 32 patients were to un dergo radical cystectomy. Results: Forty (51%) patients were T-0 at the TURB following M-VAC. Thirty (71%) patients who had chemotherapy and TURB alone are alive; at a median f ollow-up of 54+ months (8+-109+). Twenty-four (57%) have maintained an inta ct bladder. Of 13 responding patients with monofocal lesions who underwent partial cystectomy, 8 patients (62%) are alive with a functioning bladder, at a median follow-up of 80+ months (16-107+ months). At a follow-up of 32 months (7-121+ months), 20 (63%) patients in the radical cystectomy group a re alive. In patients who had downstaging to T-0 or superficial disease, me dian follow-up is 55 months (10-121+ months) and five-year survival is 71%. Patients who failed to respond (T-2 or greater after chemotherapy), at a m edian follow-up of 24 months (7-103+ months), had five-year survival of onl y 29%. Conclusions: Bladder sparing in selected patients on the basis of response to neo-adjuvant chemotherapy is a feasible approach which must be confirmed in prospective randomized trials.