Neo-adjuvant chemotherapy and bladder preservation in locally advanced transitional cell XXXX .

@entity1 @entity150
BACKGROUND: The possibility of bladder preservation as well as the utility of neo-adjuvant chemotherapy for invasive @entity150 are controversial issues. The purpose of this study was the evaluation of neo-adjuvant M-VAC chemotherapy and bladder preservation in @entity1 with locally advanced transitional cell @entity150 . @entity1 AND METHODS: Eighty-seven consecutive evaluable @entity1 with T2-T4aNxM0 TCC of the bladder were treated with three cycles of neo-adjuvant M-VAC chemotherapy. After three cycles of M-VAC, 42 @entity1 had TURB alone, 13 @entity1 underwent partial cystectomy, and 32 @entity1 were to undergo radical cystectomy. RESULTS: Forty (51%) @entity1 were T0 at the TURB following M-VAC. Thirty (71%) @entity1 who had chemotherapy and TURB alone are alive; at a median follow-up of 54+ months (8(+)-109+). Twenty-four (57%) have maintained an intact bladder. Of 13 responding @entity1 with monofocal lesions who underwent partial cystectomy, 8 @entity1 (62%) are alive with a functioning bladder, at a median follow-up of 80+ months (16-107+ months). At a follow-up of 32 months (7-121+ months), 20 (63%) @entity1 in the radical cystectomy group are alive. In @entity1 who had downstaging to T0 or superficial disease, median follow-up is 55 months (10-121+ months) and five-year survival is 71%. @entity1 who failed to respond (T2 or greater after chemotherapy), at a median follow-up of 24 months (7-103+ months), had five-year survival of only 29%. CONCLUSIONS: Bladder sparing in selected @entity1 on the basis of response to neo-adjuvant chemotherapy is a feasible approach which must be confirmed in prospective randomized trials.
