Chemotherapy for Bladder Cancer

To the Editor: On the basis of their findings in a well-designed, randomized trial involving patients with muscle-invasive bladder cancer, Grossman et al. (Aug. 28 issue) 1 conclude that neoadjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC), followed by radical cystectomy, improved survival, as compared with cystectomy alone. We want to point out some important considerations about the treatment received by patients in the control group (those treated with cystectomy alone). First, 19 percent of patients in the cystectomy-alone group (30 of 154) did not undergo cystectomy according to the protocol, and no additional information about the alternative treatments given . . .