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Neo‐adjuvant Chemotherapy for Invasive Bladder Cancer. Experience with the M‐VAC Regimen
Author(s) -
SCHER H.,
HERR H.,
STERNBERG CORA,
FAIR W.,
BOSL G.,
MORSE M.,
SOGANI P.,
WATSON R.,
DERSHAW D.,
REUTER V.,
CURLEY TRACY,
VAUGHAN E. DARRACOTT,
WHITMORE W.,
YAGODA A.
Publication year - 1989
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1989.tb06008.x
Subject(s) - medicine , bladder cancer , pathological , regimen , surgery , chemotherapy , cystectomy , cytology , methotrexate , vinblastine , urinary bladder , urine cytology , urology , cancer , pathology
Summary— A series of 71 patients with muscle invasive bladder cancer received a median of 3 cycles (range 1–6) of methotrexate, vinblastine, Adriamycin and cisplatin (M‐VAC). Efficacy assessed by transurethral resection alone showed that 48% of patients were TO, 13% Tis and 54% had normalisation of initially positive urinary cytology after treatment. However, when considering transurethral resection of the bladder (TURB), cytology and non‐invasive procedures (CT scan and/or ultrasound), only 21% had a clinical complete remission ( c CR); 48 patients (68%) had pathological evaluation and 13 (27%) were PO after treatment. Non‐responding patients had a poor prognosis: 14/30 (47%) developed metastatic disease and 13 died. In assessing the primary lesions, clinical understaging was significant. Of 15 patients who were TO cystoscopically prior to surgery, 6 (40%) had residual disease in the pathological specimen, including 4 with muscle infiltration; 23 patients (32%) remained clinically staged, only 8 of whom remain disease‐free. With a median follow‐up of 24 months (range 2–42+), 41 patients are alive and disease‐free, including 20 with a functional bladder. The large staging error raises questions concerning studies using clinical rather than pathological endpoints as the sole criteria of efficacy.