and M-VAC—look very promising. Some early results have described 60 to 70 percent complete remission
rates with bladders being preserved in limited numbers of cases. These rates were discovered clinically (by
cystoscopy), however. Only 15 to 30 percent have been found to be truly tumor-free with pathological staging
after surgery.
Results of the ongoing randomized clinical trials will have to be reviewed before these combinations are
accepted as superior to the "gold-standard" of cystectomy.
Stage III or B2 and C
TNM T3, N0, M0
A tumor that invades deeply into muscle (more than halfway through) is designated as T3a, or B2 by the Jewett-Strong-Marshall system. If it invades into perivesical fat, it is a T3b, or C by the Jewett-Strong-Marshall system.
About 35 percent of clinical Stage III cases show tumor invasion outside the bladder at the time of surgery, so survival statistics vary. For those having tumors outside the bladder, survival is low—about 20 percent—with most relapsing from distant metastases. Survival rates are much better—30 to 50 percent—for true Stage III cases that have a lower grade and in those cases where the tumor can be downstaged (reduced) after preoperative radiation therapy or chemotherapy alone or after radiation therapy plus cisplatin .
