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What to do if the lymph nodes are positive
1Department of Urology, University of Texas MD Anderson Cancer Center, Houston 77030, USA.
Seminars in Urologic Oncology
|May 1, 1996
Summary
Advanced bladder cancer with lymph node metastases has seen improved survival with multimodal therapy. Current recommendations involve chemotherapy before surgery for responders, with surgery for non-responders or those without metastases.
Area of Science:
- Uro-oncology
- Surgical oncology
- Medical oncology
Background:
- Lymph node metastases are frequent in advanced bladder cancer.
- Survival rates have increased from 15% to 30% with evolving management strategies.
- The definitive benefit of adjuvant therapies like irradiation and chemotherapy remains unproven.
Purpose of the Study:
- To outline a management strategy for advanced bladder cancer with lymph node involvement.
- To integrate chemotherapy and surgical approaches for optimal patient outcomes.
- To guide treatment decisions based on clinical staging and response to therapy.
Main Methods:
- For clinically staged nodal metastases, primary multiagent chemotherapy is recommended.
- Subsequent exploratory laparotomy, lymphadenectomy, and potential cystectomy for complete responders.
- For patients without clinical evidence of metastases, complete bilateral pelvic lymphadenectomy and cystectomy are performed if nodes are normal or resectable.
Main Results:
- Multimodal therapy has shown an apparent improvement in survival rates.
- The study proposes a treatment algorithm based on clinical staging and response.
- Patients with nodal metastases may benefit from adjuvant chemotherapy post-surgery.
Conclusions:
- A combined approach of chemotherapy and surgery is recommended for advanced bladder cancer with lymph node metastases.
- Treatment should be tailored based on clinical staging and response to neoadjuvant chemotherapy.
- Further research is needed to definitively establish the role of adjuvant therapies.