Treatment of Invasive Bladder Cancer by Local Resection and High Dose Methotrexate

Abstract

Patients (57) with transitional cell carcinoma of the bladder, categories pT2, pT3a and pT3b, were treated by transurethral resection (TUR) of the tumor mass (54 cases) or partial cystectomy (3 cases) followed by 8 doses of methotrexate 2 g i.v. every 3 wk with appropriate Leucovorin rescue. At completion of chemotherapy 6 mo. after TUR 33/57 patients were tumor-free; 5/57 had new superficial tumors; 13/57 had persistent tumor invading muscle, 3 showed tumor progression and 3 had died from treatment complications. One-year survival was 45/57 (82%); 2-yr survival was 23/39. Although some patients developed metastases and others have grown new superficial tumors, of those surviving, the bladder was free of the original invasive tumor in 38/45 (84%) at 1 yr and in 19/24 (79%) at 2 yr. Transurethral resection plus high dose methotrexate may offer an effective alternative to radiotherapy or cystectomy for a significant proportion of patients with invasive bladder cancer.