Objective: To evaluate the efficacy of the conservative management of stage T2 and T3a bladder cancer with deep (radical) transurethral resection (TUR) followed by four cycles of chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin (MVEC) and its impact on bladder preservation and tumour recurrences.
Patients and methods: Between May 1990 and June 1995, 19 patients with stage T2 or T3a transitional cell carcinoma of the bladder who refused radical cystectomy entered the study. The patients were re-evaluated 4 weeks after completion of the treatment by cystoscopy, TUR of the tumour site and multiple deep bladder biopsies. The patients were maintained on periodic local and systemic surveillance with cystoscopy and deep biopsy every 3 months, and annual intravenous urography and computed tomography.
Results: Seventeen patients completed the treatment protocol; 13 patients were tumour-free at the first evaluation after treatment and six of these had tumour recurrences in the bladder during surveillance. Eleven patients retained their bladder in a functional state for a mean duration of 36 months (range 12-62+) and seven of them remain free of recurrence after a mean duration of 41 months (range 8-58+).
Conclusion: Deep TUR of the bladder tumour followed by four cycles of MVEC chemotherapy is an effective alternative in the conservative management of patients with stage T2 and T3a bladder cancer. We suggest this protocol for patients who refuse or are unsuitable for surgery.