Cancer Management and Research (Jul 2021)
Referral for “Neoadjuvant Chemotherapy” for Muscle-Invasive Bladder Cancer to a Multidisciplinary Board: Patterns, Management and Outcomes
Abstract
Athanasios Dellis,1 Roubini Zakopoulou,2 Andromahi Kougioumtzopoulou,3 Kimon Tzannis,2 Konstantinos Koutsoukos,2 Charalampos Fragkoulis,4 Efthymios Kostouros,5 Athanasios Papatsoris,6 Ioannis Varkarakis,6 Konstantinos Stravodimos,7 Eleni Boutati,8 Stamata Pagoni,5 Miltiadis Seferlis,9 Michael Chrisofos,10 Vasilios Kouloulias,3 Konstantinos Ntoumas,4 Charalambos Deliveliotis,6 Constantine Constantinides,7 Meletios A Dimopoulos,2 Aristotelis Bamias8 1 2nd Department of Surgery, National & Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece; 2Oncology Unit, Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece; 3Radiotherapy Unit, 2nd Department of Radiology, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; 4Department of Urology, General Hospital of Athens “G. Gennimatas”, Athens, Greece; 5 3rd Department of Internal Medicine, General Hospital of Athens “G. Gennimatas”, Athens, Greece; 6 2nd Department of Urology, National & Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece; 7First Department of Urology, National and Kapodistrian University of Athens, “Laiko” General Hospital, Athens, Greece; 8 2nd Propaedeutic Department of Internal Medicine, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; 9Department of Urology, Thriasion General Hospital, Athens, Greece; 10 3rd Department of Urology, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, GreeceCorrespondence: Aristotelis Bamias 2nd Propaedeutic Department of Internal Medicine, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, GreeceTel +30 2105831256 Fax +30 210 5326454Email [email protected]: Utilization of neoadjuvant chemotherapy for the treatment of muscle invasive bladder cancer in everyday practice differs from that of clinical trials. We describe the patterns of referral for “neoadjuvant chemotherapy”, treatment and outcomes in a multidisciplinary tumor board.Methods: This was an observational study. Patients referred for neoadjuvant chemotherapy received 4 cycles of dose-dense gemcitabine/cisplatin and were then assessed for definitive local therapy. Patients had a minimum follow-up of 2 years. Primary objective was a 3-year disease-free survival rate.Results: Forty-six patients (clinical stages II: 28, IIIA: 9, IIIB: 4, IVA: 3, missing: 2) were included. Following chemotherapy, 30 underwent radical cystectomy, 8 radiotherapy and 8 no further therapy. Pathological downstaging was observed in 14 (46.6%) of the 30 patients who underwent radical cystectomy; clinical TNM staging was correlated with disease-free survival in the whole population, while clinical and pathological stages, as well as pathological downstaging, were correlated with disease-free survival in patients undergoing radical cystectomy. Three-year disease-free survival rates for the whole cohort and for patients undergoing radical cystectomy were 67.3% (95% confidence interval [CI]: 51– 79.2) and 65.2 (95% CI: 44.9– 79.6), respectively.Conclusion: Real-world muscle invasive bladder cancer patients who receive neoadjuvant chemotherapy are characterized by more advanced diseases and less frequent radical surgery than those included in clinical trials. Nevertheless, outcomes were comparable and, therefore, offering patients with stage II–IVA muscle invasive bladder cancer neoadjuvant chemotherapy after assessment by multidisciplinary tumor boards should be strongly encouraged.Keywords: bladder cancer, neoadjuvant, chemotherapy, cystectomy, radiotherapy
