Herr H W, Scher H I
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
J Clin Oncol. 1994 May;12(5):975-80. doi: 10.1200/JCO.1994.12.5.975.
This clinical trial evaluated a bladder-sparing strategy using a combined modality approach of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy followed by a partial cystectomy for patients with invasive (T2-4N0M0) bladder cancer.
One hundred eleven surgical candidates received a median of four cycles of neoadjuvant M-VAC. Following treatment, of those with a favorable response to chemotherapy based on cystoscopic examination, 26 underwent a partial cystectomy.
Of 26 patients, 17 (65%) are alive beyond 5 years (median, 6.9 years; range, 4 to 8), including 14 (54%) with an intact, functioning bladder. Twelve patients (46%) developed bladder recurrences, which were invasive in five (18%) and superficial in seven (26%). Patients with no (P0) or noninvasive (Pis) tumor in their surgical specimens had a 5-year survival rate of 87% (14 of 16), compared with 30% (three of 10) among patients with residual invasive cancer. The majority of deaths was attributed to preexisting metastases.
Neoadjuvant M-VAC chemotherapy permitted bladder-sparing surgery in selected responding patients with invasive bladder neoplasms. The bladder remained at risk for new tumor development, but local recurrences were treated successfully by local therapy or salvage cystectomy.
本临床试验评估了一种膀胱保留策略，该策略采用新辅助甲氨蝶呤、长春碱、阿霉素和顺铂（M-VAC）化疗联合部分膀胱切除术的综合治疗方法，用于治疗浸润性（T2-4N0M0）膀胱癌患者。
111名手术候选患者接受了中位4个周期的新辅助M-VAC化疗。治疗后，根据膀胱镜检查对化疗有良好反应的患者中，26例接受了部分膀胱切除术。
26例患者中，17例（65%）存活超过5年（中位生存期6.9年；范围4至8年），其中14例（54%）膀胱功能完好。12例患者（46%）出现膀胱复发，其中5例（18%）为浸润性复发，7例（26%）为浅表性复发。手术标本中无肿瘤（P0）或非浸润性肿瘤（Pis）的患者5年生存率为87%（16例中的14例），而残留浸润性癌患者的5年生存率为30%（10例中的3例）。大多数死亡归因于术前已存在的转移。
新辅助M-VAC化疗使部分有反应的浸润性膀胱肿瘤患者能够接受膀胱保留手术。膀胱仍有发生新肿瘤的风险，但局部复发可通过局部治疗或挽救性膀胱切除术成功治疗。
