THE EFFICACY OF PREOPERATIVE SYSTEMIC CHEMOTHERAPY IN THE LOCAL-CONTROL OF MUSCLE-INVASIVE TRANSITIONAL-CELL CARCINOMA OF THE URINARY-BLADDER

Transitional cell carcinoma of the urinary bladder has a poor prognosis, once the muscle layers of the bladder wall have been invaded, irrespective of whether operative or radiation therapy is chosen for local treatment. The main reason for this is probably the existence of disseminated micrometastases at the time of primary treatment. Thus, a combination of systemic and local treatment would seem logical. The present study reports the response to chemotherapy in 30 patients with muscle-invasive urinary bladder tumours and the findings at subsequent cystectomy. The chemotherapy comprised cisplatin, methotrexate and leucovorin rescue and was tolerated without any alarming side-effects or increase in perioperative morbidity or mortality. The complete response rate was 43% (13/30) and, in 27% (8/30), there was a partial response with conversion into a more superficial tumour stage. The total, beneficial response rate was thus 70%.