Adjuvant chemotherapy for invasive bladder cancer.

Area of Science:

• Urology
• Medical Oncology
• Cancer Research

Background:

• Radical cystectomy with pelvic node dissection is a standard treatment for invasive bladder cancer (pathologic stage pT3/pT4 and/or N+).
• Adjuvant chemotherapy aims to improve outcomes for patients with high-risk bladder cancer following surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of adjuvant chemotherapy regimens in patients with invasive bladder cancer post-cystectomy.
• To assess the impact of cis-platinum-based chemotherapy on survival and recurrence rates.

Main Methods:

• A cohort of 25 patients with advanced bladder cancer received adjuvant chemotherapy between 1982 and 1985.
• Chemotherapy protocols included cis-platinum alone or in combination with adriamycin and 5-fluorouracil (CAF), with some patients receiving preoperative intra-arterial infusion.
• Two main postoperative protocols were utilized: cis-platinum monotherapy and a combination regimen (cis-platinum, adriamycin, 5-fluorouracil).

Main Results:

• The overall 50-month survival rate was 77% for all 25 patients.
• Eighteen patients survived with no evidence of disease at an average of 26 months post-treatment.
• Local recurrence or distant metastasis occurred in 6 patients, with 3 surviving at an average of 20.7 months; 3 patients died from cancer progression.

Conclusions:

• Adjuvant chemotherapy, particularly regimens involving cis-platinum, demonstrates significant effectiveness in managing invasive bladder cancer after radical cystectomy.
• The observed survival rates suggest a beneficial role for adjuvant chemotherapy in preventing cancer recurrence and progression in this patient population.
• While side effects like nausea, vomiting, and mild myelosuppression were noted, the overall efficacy supports the use of these chemotherapy agents.