[Neoadjuvant and adjuvant chemotherapy of bladder cancer]

Conventional treatments such as surgery and radiotherapy for deeply invasive, clinically non-metastatic bladder cancer are associated with cure in less than 30% of cases. This has led to the search for new approaches to therapy. Based on the excellent results with combination chemotherapy such as M-VAC in patients with advanced disease, neoadjuvant or adjuvant chemotherapy has been advocated to improve survival. Twenty patients with primary invasive bladder cancer who underwent radical cystectomy received postoperative adjuvant chemotherapy using a CAP (cyclophosphamide, doxorubicin and cisplatin) or modified M-VAC (methotrexate, vinblastine, pirarubicin and cisplatin) regimen. Sixteen of the patients were treated with CAP and four with the modified M-VAC. Of the 20 patients, 17 had transitional cell carcinoma with or without non-transitional cell elements. All of the patients had tumors with a histological grade of G2 (six cases) or G3 (14 cases). As for lymph node metastasis, there were 10 N0 cases, three N1 cases, six N2 cases, and one N3 case. The five-year survival rate of these 20 patients was 65.9%, while that of 49 patients not administered any adjuvant chemotherapy was 29.9%. Regarding toxicity, both adjuvant chemotherapy regimens in this study were generally well tolerated. The most common toxic effects were gastrointestinal symptoms, alopecia and myelosuppression. Twenty other patients with invasive transitional cell carcinoma of the bladder received two or three cycles of neoadjuvant chemotherapy using the modified M-VAC or MEC (methotrexate, epirubicin and cisplatin) regimen prior to radical cystectomy or partial cystectomy. Of 19 evaluable patients who received neoadjuvant chemotherapy, a complete response was observed in two (10%), a partial response in 11 (55%), and no change in six (30%). The overall response rate was 65%. The five-year survival rate of 20 patients who received neoadjuvant chemotherapy was 74.2%. Regarding toxicity, one patient died of a bowel complication after surgery, and the complication was suggested to be drug-induced.