Carcinoma of the urinary bladder is a very common malignancy.  In the United States, it is the fourth most common cancer in men and the eighth in women.  The majority of bladder cancer patients have early stage disease, i.e., the lesions are superficial to the muscle layer of the bladder and treatment with local resection and intravesical immunotherapy or chemotherapy can effectively control the disease.  However, when the malignancy has invaded into or beyond the muscle layer of the urinary bladder, the treatment and prognosis of the disease can become very unfavorable. 

The standard treatment for muscle invading bladder cancer is radical cystectomy.  Unfortunately, even with this very invasive procedure, more than 50% of the patients with locally advanced bladder cancer will develop recurrence.  In addition, the most common type of recurrence is distant metastasis, and local treatment such as surgery or radiation has almost no curative effect.  Therefore, it is crucial for scientists to discover a more efficient treatment modality to control the migration of cancer cells to other parts of the body before or shortly after the radical surgery.

In 1987, the Southwest Oncology Group (SWOG) initiated a clinical trial to determine whether pre-operative chemotherapy can decrease the rate of distant metastasis and thus improve the survival of patients with locally advanced bladder cancer.  This research project was supported in part by the National Cancer Institute of United States, and the results of this trial were published in the New England Journal of Medicine on August 28, 2003.  Patients were enrolled into the study if they had muscle-invasive bladder cancer and were to be treated with radical cystectomy.  

The study enrolled 317 patients in total over an 11-year period.  Half of the group (154 patients) were assigned to receive radical surgery alone, and the other half received 3 cycles of chemotherapy before the surgery.  The chemotherapy regimen included methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC).  The median survival for patients receiving surgery alone was 46 months, as compared with 77 months for patients treated with combined therapy.  

As a result, the use of pre-operative chemotherapy consisting of methotrexate, vinblastine, doxorubicin, and cisplatin and radical cystectomy improves the outcome for patients with locally advanced bladder cancer compared with surgery alone, and M-VAC combined with radical surgery is a reasonable treatment option for patients with locally advanced bladder cancer.  

For more information about Bladder Cancer, please visit the Bladder Cancer Directory of the Cancer information Network.