Radical cystectoy and/or radiotherapy represent the standard treatment for invasive bladder carcinoma. However these approaches are less than ideal since a substantial number of patients have progressive disease and die of metastatic cancer. Then
recent
treatment modality is trending toward chemotherapy. Therefore, we performed the aggressive transurethral resection of the bladder tumor (TURBt) followed by the combined chemotherapy of methotrexate, vinblastin, doxorubicin and cisplatin (M-VAC)
for
conservative treatment of muscle invasive transitional cell carcinoma of the bladder. From July 1990 to March 1995, 41 patients with stage T2 to T4 were entered into the study. Of that patients, 26 completed 4 to 8 cycles of M-VAC and were
followed,
while 15 were excluded from the study because of incomplete chemotherapy or inadequate follow-up. Median follow-up was 30 months (4-56 months). Median age of the patients was 66 years (range 48 to 85 years). All patients had Karnofsky performance
status
(KPS) score between 70 and 100. There were 3 patients with clinical stage T2, 8 with T3a, 7 with T3b, 8 with T4.
G-CSF (Granulocyte-Colony Stimulating Factor) was used for 19 patients with M-VAC induced leukopenia, thereby allowing the chemotherapy to be complete on schedule. Responses to therapy were evaluated according to standard accepted phase II
response
criteria. Overall clinical response (complete and partial was noted in 15 patients (58%), and no response in 11(42%). Of the patients with T2 and T3a, 9 (82%) showed complete and partial response, and of them with T3b and T4, 6(40%) showed
complete
and
partial response. Of 26 patients 21 (81%) are alive now.
These data suggest that survival was no beteer than expected following radical cystectomy or radiotherapy in short term follow-up, so far, however systemic M-VAC chemotherapy in combination with radical TURBt is probably expected to provide a
high
response rate and a better survival with the particular advantage of preserving normal bladder function in patients with superficially invasive bladder tumor (T2/T3a).
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