[Neoadjuvant chemotherapy of infiltrating carcinoma of the bladder: our experience]

From January 1987 until October 1989, 96 patients have been treated with radical cystectomy for locally advanced bladder cancer. Nineteen, out of 96 underwent chemotherapy (either M-VAC or M-VEC) before cystectomy. Five had T1G3 bladder tumor. After chemotherapy the results had been the following: 5 complete responses (CR) 26%, 7 partial responses (PR) (37%) and no changes in 7 patients (37%). During the first two courses of chemotherapy, 36 administrations out of 152 scheduled should have not been done because of drug toxicity. The seven patients who had no changes had a drug administration reduced of 41% with respect of a rate of reduction of 12% in the group of patients who had complete response. The urinary diversion after cystectomy were performed with a neobladder according to Reddy in 4 patients, with a colon conduit in 1 patient and with an ileal conduit in 12 patients. All the patients survived the surgery. We did not notice any difference in the follow up after surgery in those patients treated before cystectomy with chemotherapy with respect to the patients who underwent cystectomy without chemotherapy. Despite the fact that by now we can not state any conclusion about the efficacy of neoadiuvant chemotherapy, due both to the short follow up and to the small number of patients treated, we should however perform cystectomy in all the patients after chemotherapy because up to now we have no evidence that a conservative treatment of the bladder after chemotherapy could be safe.