Infiltrating transitional carcinoma of the bladder. Preoperative or neoadjuvant chemotherapy. our experience with 38 patients with long-term follow-up
Escudero Barrilero, A.; Fernández Fernández, E.; Crespo Maffieu, C.
Archivos Espanoles de Urologia 47(3): 219-231
1994
ISSN/ISBN: 0004-0614 PMID: 8024328 Document Number: 430316
We reviewed the clinical records of 37 patients who had been treated with neoadjuvant chemotherapy + radical cystectomy and bilateral lymphadenectomy. The patients were followed until they died and the survivors have a follow-up of 43 to 68 months. There were 28 deaths: 20 patients died within 24 months following treatment and 6 died after two years. Five patients were not submitted to surgery due to rapid tumor progression while they were receiving cytostatic therapy. Bladder removal was ruled out in 5 patients with important loco-regional spread demonstrated on laparotomy. The bladder was preserved in 12 patients. Eight patients had cRC: 1 died from causes unrelated to the disease; 1 was lost to follow-up at 16 months, with no evidence of bladder cancer or metastasis; 3 developed distant metastasis, and 3 are alive and tumor-free. One pCR died with evidence of metastasis; 1 cRP required radical cystectomy and died from metastasis. Of the patients classified as sRC, 1 subsequently underwent radical cystectomy and is disease-free and the other died from metastasis. Fifteen patients underwent radical cystectomy: 3 are alive and tumor-free, 2 were lost to follow-up and 10 patients died (3 from causes unrelated to the disease and 7 died from the disease). Lymph node invasion was observed in 54%. Metastasis was observed in 57.3% and local recurrence in 17.3%. The preoperative chemotherapy schedule under study did not prolong the metastasis-free period in this group of patients.