الفهرس 
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Abstract
Many bladder cancer patients do not die of their disease but do experience multiple recurrences. As a consequence, there are a relatively large number of people alive with a history of bladder cancer. In middle-aged and elderly men, bladder cancer is the second most prevalent malignancy after prostate cancer . (5,6)
Surgery in the form of radical cystectomy with urine diversion is the standard treatment for muscle invasive bladder cancer. A pelvic lymph node dissection (PLND) is considered an integral part of the surgical management of bladder cancer.
Data conflict existed regarding the role of adjuvant systemic chemotherapy in invasive bladder cancer because no randomized comparisons of adequate sample size have definitively shown a survival benefit of such therapy. (49, 50)
Regarding neoadjuvant chemotherapy, as revealed in trials and meta analyses, neoadjuvant chemotherapy improved 5-year overall and disease-free survival (5% and 9% absolute improvement, respectively).
Approximately 25 percent of patients will have muscle-invasive disease and either present with or later develop metastases. Systemic chemotherapy is the standard approach for patients with inoperable locally advanced or metastatic urothelial malignancies.
The aim of the present work was:
• Assessing local tumor control and minimum 2 year overall survival.
• Assessing tumor response to neoadjuvant chemotherapy (MVAC).
• Assessing the complication rates in both arms.
All patients were divided into:
group I: (30 patients)
They received 3 cycles of methotrexate, vinblastine, cisplatin and doxorubicin followed by radical cystectomy.
group II: (30 patients)
They underwent radical cystectomy .
group I is subjected to the following:
• Three cycles of M-VAC chemotherapy that was repeated every 28 days according to the recovery of the bone marrow.
• History and clinical examination: every cycle of treatment.
• Laboratory and biochemical studies: every cycle of treatment.
• Chest X ray and CT abdomen and pelvis pretreatment.
• Diffusion weighted MRI abdomen and pelvis (either before or after biopsy by 4 weeks), before and after treatment with chemotherapy.
• Radical cystectomy was performed by a urologist after 3 cycles MVAC after passing the nadir (lowest blood count) of the third cycle of chemotherapy.
Statistical analysis of data obtained from the present study revealed the following results:
1. The most common toxicity of M-VAC was neutropenia (46%) followed by nausea (40%), febrile neutropenia (26%)and vomiting(26%).
2. Recurrence either local or distant is decreased in patients who received neoadjuvant chemotherapy. But difference wasn’t significant.
3. Postoperative morbidity isn’t increased in neoadjuvant group when compared with surgery arm
4. DFS was increased in neoadjuvant group. But difference wasn’t significant.
5. DW MRI is a promising tool in estimating response to neoadjuvant chemotherapy.
6. DW MRI shows substantial agreement with radical cystectomy pathology specimen.
Conclusion:
• Neoadjuvant chemotherapy is a standard of care in treating muscle invasive bladder cancer.
• DW MRI could be used in assessing response to neoadjuvant chemotherapy.