[Systemic chemotherapy with cisplatin, methotrexate, and vinblastine, and bladder preservation in T2/T3a bladder...

We are currently witnessing a lively controversy over which should be the optimal treatment for patients with infiltrant urothelial carcinoma with muscle location (stage B Jewett's Grading or T2-T3 on the TNM Rating Scale, UICC 1992). This paper reports a randomized, prospective study in 37 patients with T2-T3a tumours. Arm A (n = 20) received systemic chemotherapy with cisplatin, methotrexate and vinblastine (CMV) after TUR, and was carefully followed aiming for vesical preservation. Arm B (n = 17) was given chemotherapy with CMV after TUR and then underwent cystectomy. Disease-free survival at 5 years for the overall series is 69%, 47% for group A and 88% for group B (log-rank, p = 0.14). No statistically significant differences in survival were detected relative to age (under or over 65 years), growth patterns (papillary or plain), histological grade (G2 or G3), and size (smaller or greater than 5 cm). Survival was different depending on the clinical suspicion of nodular involvement (log-rank, p < 0.001). In summary, although the number of patients in the series does not allow to draw conclusions in terms of statistical significance, there is enough evidence to consider that vesical preservation based on TUR and systemic chemotherapy as definitive treatment is a dangerous option without the good survival rates achieved by T2/T3a patients undergoing cystectomy.