Fifteen patients with advanced transitional cell carcinoma of the urothelial tract were treated with methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy. Eleven patients were treated to metastatic lesions after surgical resection of primary cancers. One out of 15 patients died of chemotherapy. Of the remaining 14 patients, CR was achieved in one and PR was achieved in seven, clinically. The response rate was 57.1% and the median response duration was 12.6 months. In the patients who had been resected their primary lesions, the response rate was 70% and the duration was 14.1 months. Six patients, including five PRs and one NC, underwent surgical resection and re-staging of the residual tumors after chemotherapy. Clinical response coincided with pathological one in all 6 cases. Three patients were observed the decrease of the lung metastasis, which rate was more than 90%. Two out of 3 who did not show any invasion into the lymph channels in the resected residual tumors, have been free of a recurrence through-out the course of at 47 or at 42 months. However, another patient with lymph channel invasion died of metastasis of the mediastinal and paraaortic lymph nodes. Regarding the frequency of side effects, it seemed to be no significant difference between full and 80% doses administration. In the effectual cases, the residual tumors should be resected surgically and re-staged pathologically.