Although controversy over the relative efficacy of full-dose pelvic radiation and radical cystectomy, with or without pre-operative radiation, continues, none of these treatments directed only at the disease in the pelvis cures more than 50 percent of patients with locally advanced disease. An effective systemic therapy is needed. The most effective single agent in metastatic bladder cancer, Cis-platin, has not altered the cure rate when used as an adjuvant. Limited trials using Cis-platin based three and four drug combination chemotherapy regimens have yielded 50-70 percent overall response rates with 30 percent complete responses in metastatic disease. It seems appropriate to perform pilot studies using these more intensive programs as adjuvant chemotherapy for good performance status patients at high risk of progression, e.g. positive lymph nodes.
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