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Neo-adjuvant chemotherapy for invasive bladder cancer. Experience with the M-VAC regimen.
- Source :
-
British journal of urology [Br J Urol] 1989 Sep; Vol. 64 (3), pp. 250-6. - Publication Year :
- 1989
-
Abstract
- 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 (cCR); 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.
- Subjects :
- Adult
Aged
Carcinoma, Transitional Cell pathology
Carcinoma, Transitional Cell surgery
Cisplatin administration & dosage
Combined Modality Therapy
Doxorubicin administration & dosage
Female
Humans
Male
Methotrexate administration & dosage
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Urinary Bladder Neoplasms pathology
Urinary Bladder Neoplasms surgery
Vinblastine administration & dosage
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Carcinoma, Transitional Cell drug therapy
Urinary Bladder Neoplasms drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0007-1331
- Volume :
- 64
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- British journal of urology
- Publication Type :
- Academic Journal
- Accession number :
- 2804561
- Full Text :
- https://doi.org/10.1111/j.1464-410x.1989.tb06008.x