[Neoadjuvant chemotherapy using methotrexate and cisplatin in locally advanced urothelial cancer of the bladder]

Thirty-one consecutive patients with clinically and histologically documented urothelial cancer of the urinary bladder of category T3-T4a, N0, M0 underwent a trial of neoadjuvant chemotherapy before radical cystectomy. All patients received 2 courses of methotrexate 300 mg/m2 day 1 followed by folinic acid rescue days 2 and 3 and cisplatin 100 mg/m2 day 4, q. 3 weeks. Only responders were to receive 2 further courses of chemotherapy. The protocol was violated in 5 cases and all did poorly. Of the remaining 26 patients, 19 (73%) had a partial or complete remission to neoadjuvant chemotherapy. The actuarial disease-free survival was very encouraging at 18 months (87% for responders versus 43% for the 7 non responders), but at 30 months the difference became minimal (60% versus 43%). Furthermore, all 3 responders who had refused radical cystectomy relapsed locally. Postoperative randomized trials are necessary to prove the advantage of neoadjuvant therapy with a long term survival and bladder preservation.