S0219, Combination Chemotherapy Followed By Observation or Surgery in Patients With Stage II or Stage III Cancer of the Urothelium

DISEASE CHARACTERISTICS:

Histologically confirmed muscle-invasive (T2-T4a), node-negative (N0) urothelial transitional cell cancer (TCC) of the bladder
Focal squamous and/or adenocarcinoma differentiation, defined as ≤ 10% of tumor volume allowed

The following diagnoses are not allowed:

Small cell carcinoma
Sarcomatoid components

Disease diagnosed with an initial transurethral resection of bladder tumor (TURBT) and a second TURBT performed within 8 weeks of first with attempt to remove all tumor present

Residual disease after second TURBT allowed
No more than 14-56 days after second TURBT
No metastatic disease by chest x-ray and CT scan or MRI of the abdomen and pelvis
Fresh tumor tissue, paraffin tumor tissue, unstained slides, or cell block specimen from one or both TURBTs available

PATIENT CHARACTERISTICS:

Age

18 and over

Performance status

Zubrod 0-2

Life expectancy

Not specified

Hematopoietic

White blood cell count (WBC) at least 3,500/mm^3
Absolute granulocyte count at least 1,500/mm^3
Platelet count at least lower limit of normal

Hepatic

Bilirubin no greater than 1.5 mg/dL
Aspartate aminotransferase (SGOT) no greater than 2 times upper limit of normal

Renal

Creatinine no greater than 2.0 mg/dL AND/OR
Creatinine clearance at least 60 mL/min

Other

No prohibitive medical risk that would preclude radical cystectomy
No other serious concurrent systemic disorder that would preclude study compliance
No other malignancy except adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, adequately treated stage I or II cancer in complete remission, or any other cancer for which patient has been disease-free for 5 years
Not pregnant or nursing
Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

Prior intravesical immunotherapy allowed

Chemotherapy

No prior systemic chemotherapy for TCC of the urothelium
Prior intravesical chemotherapy allowed

Endocrine therapy

Not specified

Radiotherapy

No prior radiotherapy for TCC of the urothelium
No concurrent radiotherapy

Surgery

See Disease Characteristics