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High Incidence of Brain Metastases in Patients Treated with an M-VAC Regimen for Advanced Bladder Cancer

Objective: We report on central nervous system metastases from urothelial bladder carcinoma in patients treated with M-VAC chemotherapy. Methods: 50 patients with advanced transitional cell carcinoma of the bladder were treated with the M-VAC regimen at the Hôpital Cochin (Paris, France) between December 1989 and February 1995. Brain relapses were diagnosed by CT scanning. Results: We observed a surprising increase in the number of central nervous system relapses (8/50) in patients treated consecutively at the same institution. The mean time to metastatic recurrence in the brain from the initiation of first chemotherapy was 21 months (range 7–38). Six patients had single and 2 patients had multiple central nervous system metastases. Treatment consisted of radiotherapy alone (n = 5) or both surgery and radiotherapy (n = 3). Median survival time from the appearance of cerebral metastases was 3 months (range 1–10). Conclusion: The prolonged duration of remissions which are achieved following M-VAC chemotherapy may explain the greater likelihood of the detection of cerebral involvement.