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Published on: February 12, 2017
Perioperative chemotherapy for localized bladder cancer
1University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada.
The Canadian Journal of Urology
|March 11, 2006
Summary
Perioperative chemotherapy offers survival benefits for muscle-invasive urothelial cancer. Patients should be referred to medical oncologists, but surgical factors also significantly impact survival.
Area of Science:
- Urology
- Oncology
- Clinical Trials
Background:
- Recent meta-analyses suggest survival benefits from perioperative chemotherapy for muscle-invasive urothelial cancer.
- Lack of awareness and controversy hinder the adoption of these findings in clinical practice.
Purpose of the Study:
- To review and scrutinize the evidence for perioperative chemotherapy in muscle-invasive urothelial cancer.
- To assess the impact of chemotherapy and surgical factors on patient survival.
Main Methods:
- Narrative review of meta-analyses of randomized clinical trials (RCTs) on perioperative chemotherapy for bladder cancer.
- Inclusion of data from recent RCTs on neoadjuvant chemotherapy.
Main Results:
- Cisplatin-based neoadjuvant chemotherapy shows a 5% absolute survival benefit at 5 years.
- Adjuvant chemotherapy demonstrates a 9% absolute survival benefit at 3 years, though data are limited.
- Positive surgical margins and fewer than 10 lymph nodes removed correlate with poorer prognosis; pathological complete response indicates better survival.
Conclusions:
- Patients with muscle-invasive urothelial cancer may benefit from perioperative chemotherapy and routine referral to medical oncologists.
- Surgical factors may influence survival more than perioperative chemotherapy.
- Ongoing RCTs for localized muscle-invasive bladder cancer are a priority.
