Between June 1982 and July 1990, 55 patients (41 with
bladder cancers and 14 with renal pelvic or
ureteral cancers) who had undergone radical extirpative surgery and/or node dissection for pathological stage pT2-4 and/or nodal disease received
adjuvant chemotherapy consisting of
cisplatin alone or in combination with other agents. In all, 26 of the
bladder-cancer patients also received preoperative
chemotherapy consisting of arterial infusion of
cisplatin,
mitomycin C, and
Adriamycin.
Adjuvant chemotherapy was performed according to the following protocol. Between June 1982 and July 1987, 30-50 mg/m2
cisplatin either alone or in combination with
Adriamycin and
5-fluorouracil (CAF) was given to 35 patients in an induction and maintenance setting for 1 year. After July 1987, short-course
cisplatin (70 mg/m2) or
cisplatin,
etoposide, and
Adriamycin combination chemotherapy (CVA) was given to 20 patients. Of the 55 patients, 38 are alive and show no evidence of disease, three are alive with disease, 13 have died of their disease, and 1 has died of an unrelated cause. The 5-year survival of all patients was 65.1%. The survival of the 20 patients who were treated after July 1987 was better than that of the 35 patients who were treated before June 1987. Local recurrence and/or distant dissemination occurred in 16 patients, 13 of whom died of
cancer progression.
Nausea and
vomiting and
anorexia occurred in most patients during the administration of
cisplatin. Mild to moderate myelosuppression developed in patients who received CAF or CVA
combination chemotherapy. Although
adjuvant chemotherapy combined with radical surgery seemed to be effective in cases with a pathological stage of pT3a or less, more intensive pre- or postoperative
chemotherapy is needed to improve the poor prognosis of patients with deeply invasive uroepithelial
cancer.