Retrospective analysis of the efficacy of two cycles of M-VAC neoadjuvant chemotherapy followed by radical cystectomy for muscle-invasive bladder cancer.

BACKGROUND Neoadjuvant chemotherapy before radical cystectomy for muscle-invasive bladder cancer is a commonly used treatment modality. However, in terms of chemotherapeutic regimens and the number of cycles of neoadjuvant chemotherapy, there is yet no international consensus, as various studies indicate the efficacy of several platinum-based combination chemotherapeutic regimens. We determined the efficacy of two cycles of neoadjuvant chemotherapy with methotrexate, vinblastine, adriamycin, and cisplatin followed by radical cystectomy. PATIENTS AND METHODS The study population included patients with clinical stage T2 - T4a, N0, M0 bladder cancer who underwent radical cystectomy. Clinical courses were compared between 27 patients treated with two cycles of M-VAC neoadjuvant chemotherapy and 25 treated with cystectomy alone. RESULTS The incidence of pT0 was 25.9% in the group treated with neoadjuvant chemotherapy. The probabilities of disease-free and cause-specific survival were significantly higher in patients treated with, than without neoadjuvant chemotherapy. On univariate Cox proportional hazards regression analysis for the patients treated with neoadjuvant chemotherapy, pathological stage and the pathological findings of venous involvement were significant prognostic factors. CONCLUSION The results of this retrospective study demonstrated the clinical effectiveness of two cycles of neoadjuvant M-VAC chemotherapy for muscle-invasive bladder cancer.