Combined treatment approaches in regionally advanced bladder cancer

Urol Clin North Am. 1992 Nov;19(4):761-74.


Multimodal therapy for locally advanced bladder carcinoma is being pursued in a wide diversity of protocols at this same time. While a number of innovative approaches are being explored, neoadjuvant and adjuvant chemotherapy in conjunction with cystectomy remains the dominant approach. The M-VAC regimen has become the dominant combination for the treatment of advanced bladder cancer; its use in an adjunctive setting is a logical progression. Although it is capable of effecting a response in the primary bladder lesion in a high percentage of cases, it is still not known whether survival will be enhanced. The use of radiosensitizing cytotoxics in conjunction with neoadjuvant chemotherapy, when combined with external-beam radiotherapy, is a provocative new approach that attempts to achieve both bladder salvage and enhanced patient survival. Completion of well-designed randomized studies will be necessary to determine whether these therapeutic innovations will yield any clinical benefit.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoma, Transitional Cell / therapy*
  • Chemotherapy, Adjuvant
  • Cisplatin / administration & dosage
  • Combined Modality Therapy
  • Cystectomy*
  • Doxorubicin / administration & dosage
  • Humans
  • Methotrexate / administration & dosage
  • Radiation-Sensitizing Agents
  • Urinary Bladder Neoplasms / therapy*
  • Vinblastine / administration & dosage


  • Radiation-Sensitizing Agents
  • Vinblastine
  • Doxorubicin
  • Cisplatin
  • Methotrexate

Supplementary concepts

  • M-VAC protocol