BACKGROUND: Despite aggressive local therapy, patients with locally advanced bladder cancer are at significant risk for metastases. We evaluated the ability of neoadjuvant chemotherapy to improve the outcome in patients with locally advanced bladder cancer who were treated with radical cystectomy.

METHODS: Patients were enrolled if they had muscle-invasive bladder cancer (stage T2 to T4a) and were to be treated with radical cystectomy. They were stratified according to age (less than 65 years vs. 65 years or older) and stage (superficial muscle invasion vs. more extensive disease) and were randomly assigned to radical cystectomy alone or three cycles of methotrexate, vinblastine, doxorubicin, and cisplatin followed by radical cystectomy.

RESULTS: We enrolled 317 patients over an 11-year period, 10 of whom were found to be ineligible; thus, 154 were assigned to receive surgery alone and 153 to receive combination therapy. According to an intention-to-treat analysis, the median survival among patients assigned to surgery alone was 46 months, as compared with 77 months among patients assigned to combination therapy (P=0.06 by a two-sided stratified log-rank test). In both groups, improved survival was associated with the absence of residual cancer in the cystectomy specimen. Significantly more patients in the combination-therapy group had no residual disease than patients in the cystectomy group (38 percent vs. 15 percent, P<0.001).

CONCLUSIONS: As compared with radical cystectomy alone, the use of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin followed by radical cystectomy increases the likelihood of eliminating residual cancer in the cystectomy specimen and is associated with improved survival among patients with locally advanced bladder cancer. Copyright 2003 Massachusetts Medical Society

Written by:
Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP Jr, Raghavan D, Crawford ED.   Are you the author?
M.D. Anderson Cancer Center, Houston, USA.

Reference: N Engl J Med. 2003 Aug 28;349(9):859-66.


PubMed Abstract
PMID: 12944571

 

 

Calendar

Upcoming Events
April 5-8, 2024
The 39th Annual European Association of Urology Congress (EAU) is a four-day event including; live surgery, state-of-the-art lectures, case discussions and debates. Thousands of abstracts are submitted each year by emerging scientists and the EAU offers hundreds of them a chance to present their research. The Annual Congress is also an opportunity for young urologists to attend educational courses by the European School of Urology, and to hone their surgical skills through a variety of hands-on-training workshops.

Location: Paris, France
at the Paris Convention Centre

Program
April 5-10, 2024
The AACR Annual Meeting is the focal point of the cancer research community, where scientists, clinicians, other health care professionals, survivors, patients, and advocates gather to share the latest advances in cancer science and medicine. From population science and prevention; to cancer biology, translational, and clinical studies; to survivorship and advocacy; the AACR Annual Meeting highlights the work of the best minds in cancer research from institutions all over the world.

Location: San Diego, California
at the San Diego Convention Center

Program
April 25-27, 2024

The Advanced Prostate Cancer Consensus Conference (APCCC) was initiated to provide a forum to discuss and debate current questions on the clinical management of men with advanced prostate cancer, with a special focus on these unclear situations. Two days of the conference are dedicated to high-level presentations, discussions, and debates to summarize and conceptualize the available literature and evidence.

The conference concludes with voting by an interdisciplinary expert panel on pre-defined consensus questions targeting areas of clinical relevance. Following the conference, a manuscript with these expert recommendations is published in a peer-reviewed journal (Annals of Oncology in 2015; European Urology in 2017, 2019, 2021 and 2022 Part I and European Journal of Cancer Part II).

Location: Lugano, Switzerland
at the Palazzo dei Congressi Lugano

Program
May 3-6, 2024
The 2024 AUA Annual Meeting in San Antonio will provide the latest evidence-based science and education in urology! Over a hundred hours of science and education will be offered at AUA2024, covering the full spectrum of urology. Explore the full program of groundbreaking research, new clinical guidelines and updates, and the latest advances in urology medicine.

Location: San Antonio Texas
at the Henry B. González Convention Center

Program
May 3, 2024
Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Annual Meeting at the Annual AUA meeting.

SUFU aims to optimize the care of women, men, and children with lower urinary tract dysfunction and/or pelvic floor disorders through education, research and involvement in health care policy.

Location: San Antonio, TX
at the Grand Hyatt San Antonio

Program
May 4, 2024
The Society of Urologic Oncology (SUO) Annual Meeting At the AUA

Location: San Antonio, TX
at the Grand Hyatt San Antonio