Although patients with muscle invasive bladder cancer (MIBC) are at significant risk for metastases, treatment remains limited to radical cystectomy with or without platin-based neoadjuvant and/or adjuvant chemotherapy.
We retrospectively examined all MIBC patients who underwent radical cystectomy (RC) in our centre, between January 2010 and December 2014. Patient demographics, pre-treatment clinical stage, type of chemotherapy and post-RC pathologic data were reviewed.
A total of 64 RC were performed for stage cT2-T4 urothelial carcinoma of the bladder, median patient age was 70 years, with a significantly higher male prevalence (90.6 vs 9.4%). Median time from diagnosis to surgery was 2,2 months. At the time of diagnosis, 53 patients had clinical node negative MIBC. Of the 64 patients, only one received four cycles of neoadjuvant chemotherapy with gemcitabine and cisplatin; the remaining candidates underwent upfront surgery. The pathologic stage classification was higher than predicted clinical stage classification in 45% of patients. A total of 11 patients were pathologic stage T3-T4N0, whereas 16 had node positive disease. Of those who underwent isolated RC, 6 (9,5%) high-risk patients received combined adjuvant chemotherapy with either cisplatin or carboplatin and gemcitabine.
Given that neoadjuvant chemotherapy is thought to provide additional benefit in large numbers of patients with clinically localized MIBC and adjuvant chemotherapy in those with T3-4 and/ or node positive disease, our aim is to rise up the rate of neoadjuvant/adjuvant chemotherapy in MIBC patients at our institution, by creating a centralized referral system which would ensure rapid time to consultation, chemotherapy delivery and referral back for RC.
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All authors have declared no conflicts of interest.