A study was performed to evaluated the effect of M-VAC(methotrexate, vinblastine, doxorubicin and cisplatin) chematheraty for advanced transitional cell carcinoma of the urinary tract. During July 1987 to June 1993, sixty eight patients with histologically proven advanced transitional cell carcinoma were treated with M-VAC chemotherapy at Seoul National University HospitaL Amang them, 43 patients with index lesions who received more than 2 cycles of chemotherapy, and were adequately followed up were analyzed for M-VAC chematherapy. Thirty nine patients were men and 4 women with the median age of 59 years. They were followed for 9 to 61 months with the median of 27 months after completion of chemotherapy. Of 43 eligible patients, complete remission was found in 9 patients(20.9%) and partial remis- sion in 1 l(25.6%), showing 46.5% of overa11 response rate. The overall median survival of the 43 patients were 14 months. In 9 patients with complete remission, the median duration of remis- sion was more than 20 months and median survival was more than 25 months with the two year survival rate of 100%. In 11 patients with partial remission, the median duration of remission was 11 months and median survival was 19 months with the one year survial rate of 81.8% and two year survival rate of 30%. The median survial of the 23 nonresponders was 10 months, with one and two year survival rate of 39.1% and 4.8%. Of the l4 patients with lymph node metastasis without any distant metastasis, 7 patients(50%) showed complete remission and another 3 patients(21.4%) showed partial remission, with the overall response rate of 72.4%. In con- trary, of the 29 patients with distant metastasis with or without nodal metastasis, the overall response rate was 34.5% including complete remission of only in 2 patients(6.9%). Toxicity was not negligible. Myelosuppression was observed in 58.1% of the patients, sepsis in 11.6/, renal toxicity in 48.8% and mucositis in 39.5%, but chemotherpy related death was not observed. M-VAC chemotherapy is apparently beneficial in patients with advanced transitional cell carcinoma of the urinary tract, especially with nodal metastasis, despite significant toxicity.
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