Abstract
Between January 1991 and October 1993, 32 consecutive patients with documented primary bladder tumours invading muscle received 3 cycles of methotrexate, vinblastin, doxorubicin and cisplatin (MVAC). The disease was re-staged by bimanual examination with the patient under anaesthesia, CT scanning and transurethral biopsy or resection. Of the 32 patients 2 underwent total or partial cystectomy and 30 did not, because re-staging showed no residual tumour in 8 (25%), stage T1–2 in 12 (37.5%) and far-advanced tumour in 10 (31.2%). The median follow-up was 2.8 years. Twelve patients with stage T1–2 tumour have required TUR, and cystectomy has not been necessary. Two patients who underwent total/partial cystectomy were all downstaged pathologically. Of the 10 failures 5 patients died of disease and 5 are alive with metastatic disease.
The overall survival rate was 84.3% (27 of 32) and was 96.8% for patients with a functioning bladder.
The data suggested that this active regimen can clinically induce down-staging in a significant number of patients with primary muscle-infiltrating bladder tumours.
Transurethral resection plus MVAC chemotherapy is important for increased curability in patients with advanced bladder cancer.
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Lekili, M., Ayder, A.R., Minareci, S. et al. Conservative management of advanced bladder cancer. International Urology and Nephrology 27, 747–752 (1995). https://doi.org/10.1007/BF02552141
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DOI: https://doi.org/10.1007/BF02552141