Chemotherapy before radiotherapy for T3 bladder cancer. A pilot study

Seventeen patients with stage T3 bladder cancer were treated in a pilot study of initial chemotherapy (four courses of cyclophosphamide, methotrexate and 5-fluorouracil) followed by megavoltage radiotherapy 6000 cGy) to the bladder. Chemotherapy was well tolerated and did not lead to any increase in toxicity from the radiotherapy. Assessment of response in all cases was not possible because of the variable extent of the initial biopsy. Of the 12 patients in whom assessment was possible, there was no objective change in 9 (4 cases of T3a; 5 cases of T3b) and there was objective evidence of disease progression in 3 (2 cases of T3a; 1 case of T3b). Thirteen patients have now died and the median survival for patients in this study was 27 months, with a 3-year survival rate of 26%. Three patients died with recurrence in the pelvis, 5 with both local and metastatic disease, 2 with metastases only, and 3 from other causes. These data indicate that this particular form of chemotherapy given as initial treatment for T3 bladder cancer does not appear to lead to an improvement in the results obtained from radiotherapy alone.