Ruolo attuale della chemioterapia nel carcinoma transizionale della vescica muscolo-invasivo

The present role of chemotherapy in the mana. gement of muscle-invasive transitional cell bladder cancer. The results obtained with chemotherapy (CT) in the management of muscle-infiltrating transitional cell bladder carcinoma (TCBC) are compared with those of radiotherapy (RT) and surgery (S)_ Cisplatin and methotrexate are the most effective agents, with an overall response rate ranging from 20 to 45 % when administered singly. Other chemotherapeutic drugs whichproved of some antitumor activity in TCBC are doxorubicin and vinblastine, with an overall response rate of approximately IS % (range 4-28 %)_ With each drug used singly, however,complete response (CR) is uncommon. Combination CT regimens (cisplatin+methotrexate, cisplatill+methotrexate+vinblastine, methotrexate+vinblastine+doxorubicin+cisplatin) are inducing a higher number of CR with an overall response rate between 40 and 70 %. CT, previously used as adjuvant or salvagetherapy in advanced TCBC, is now given in neo-adjuvant fashion in order to achieve tumor size reduction and control of micrometastases.With these multiagent regimens a significant down-staging can be obtained without major toxicity in over SO % of patients withmuscle-infiltrating TCBC, thus increasing the number of patients which can be cured by surgery. These neo-adjuvant programs suggests potential benefit, yet randomized studies andprolonged observations are required to provide definitive results.