Treatment of metastases from bladder cancer. Outcome of a prospective trial

We initiated a prospective phase II trial to assess the outcome of complete surgical removal of metastases from bladder cancer with regard to survival and quality of life. Between 1995 and 1999, 70 patients (52 males, 18 fema les) with a median age of 64 years (range: 30-88 years) were treated with s urgical complete resection of bladder cancer metastases. Patients with asym ptomatic (n = 19) and symptomatic (n = 51) secondary metastases from bladde r cancer refractory to methotrexate, vinblastine, doxorubicin, and cisplati n (M-VAC) therapy were included. We removed secondary metastases in lymph nodes (63%), peritoneum (10%), ski n (3%), bone (3%), lung (15%),and liver (6%) and measured survival and perf ormance scores. The median survival time was 7 months. With a 1-year surviv al rate of 30% and a 2-year survival rate of 19%, the prognosis is unfavora ble independent from the site of metastasis. However, 83% (42 of 51) of the patients with symptomatic secondary metastases did benefit from surgery re garding quality of life, e.g., performance score, and we assessed an improv ement in the WHO performance score from 3.3 to 2.1 (p = 0.005). Surgical re moval of metastases from bladder cancer refractory to systemic therapy has an impact on quality of life limited to patients with symptomatic disease.