Neo-adjuvant chemotherapy and bladder preservation in locally advanced transitional cell carcinoma of the bladder

Background: The possibility of bladder preservation as well as the utility of neo-adjuvant chemotherapy for invasive bladder cancer are controversial issues. The purpose of this study was the evaluation of neo-adjuvant M-VAC chemotherapy and bladder preservation in patients with locally advanced transitional cell carcinoma of the bladder.Patients and methods: Eighty-seven consecutive evaluable patients with T₂–T_4aN_xM₀ TCC of the bladder were treated with three cycles of neo-adjuvant M-VAC chemotherapy. After three cycles of M-VAC, 42 patients had TURB alone, 13 patients underwent partial cystectomy, and 32 patients were to undergo radical cystectomy.Results: Forty (51%) patients were T₀ at the TURB following M-VAC. Thirty (71%) patients who had chemotherapy and TURB alone are alive; at a median follow-up of 54+ months (8+–109+). Twenty-four (57%) have maintained an intact bladder. Of 13 responding patients with monofocal lesions who underwent partial cystectomy, 8 patients (62%) are alive with a functioning bladder, at a median follow-up of 80+ months (16–107+ months). At a follow-up of 32 months (7–121+ months), 20 (63%) patients in the radical cystectomy group are alive. In patients who had downstaging to T₀ or superficial disease, median follow-up is 55 months (10–121+ months) and five-year survival is 71%. Patients who failed to respond (T₂ or greater after chemotherapy), at a median follow-up of 24 months (7–103+ months), had five-year survival of only 29%.Conclusions: Bladder sparing in selected patients on the basis of response to neo-adjuvant chemotherapy is a feasible approach which must be confirmed in prospective randomized trials.