Adjuvant chemotherapy for uroepithelial transitional cell carcinoma

The effectiveness of adjuvant chemotherapy in transitional cell carcinoma of the bladder (T1/G3 and >=T2) and the upper urinary tract were evaluated. Among a group of 136 patients (male 107, female 29) with such tumors, complete tumor resection was possible in 108, in whom durationof survival and disease-free interval with or without chemotherapy were compared. The combination of antineoplastic agents used was changed from 5-fluorouracil (5-FU)+vincristine (VCR)+bleomycin (BLM) or pepolomycin (PEP)+mitomycin C (MMC) or 5-FU+VCR+PEP+cyclophosphamide (CPM)+adriamycin (ADM) to CPM+ADM+cis-platinum (DDP) or methotrexate (MTX)+vinblastine (VBL)+ADM+DDP. Of the 59 patients in the chemotherapy group, 23 (39%) had side effects due to the treatment; however, fever and gastrointestinal symptoms were the chief adverse effects and were well tolerated. The 5-year survival rate and mean disease-free interval in the chemotherapy group were 76.3% and 24.6+ months, respectively, in bladder cancer patients, and 78.2% and 25.8+ months in those with upper urinary tract tumors. However, in the nonchemotherapy group (n=49) the corresponding values were 62.7% and 21.1+ months in patients with bladder cancer and 67.3% and 42.0+ months in those with upper urinary tract tumor. There was a statistically significant difference (P<0.05) in the disease-free intervals of the two treatment groups for bladder cancer patients. Recurrence, regardless of time, was observed in 25% of chemotherapy cases and in 65% of non-chemotherapy cases, and this difference was also statistically significant (P<0.001). These results suggest that adjuvant chemotherapy for uroepithelial transitional cell carcinoma may be effective in extending survival and significant by protracting the disease-free period, especially in cases of advanced bladder cancer.