Wei Shen Tan1, Benjamin W Lamb2, Heather Payne3, Simon Hughes4, James S A Green5, Tim Lane6, Jim Adshead6, Greg Boustead6, Nikhil Vasdev6. 1. Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom. Electronic address: tanweishen@hotmail.com. 2. Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom. 3. Department of Oncology, University College London Hospitals, London, United Kingdom. 4. Department of Oncology, Guy's Hospital, London, United Kingdom. 5. Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Department of Health and Social Care, London Southbank University, London, United Kingdom. 6. Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, United Kingdom.
Abstract
INTRODUCTION: Because of the lack of published evidence, this study was done to explore the decisions and rationale of uro-oncology consultants regarding the treatment of patients with muscle-invasive bladder cancer who have positive lymph nodes after radical cystectomy (RC) and neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: An electronic survey was sent to UK pelvic cancer centers regarding: (1) choice of NAC regimen; (2) indications for reimaging; (3) choice and indication of adjuvant chemotherapy (AC) for patients with nodal disease after NAC and RC; (4) choice and indication of chemotherapy regimen if disease continues to progress in patients with advanced bladder cancer; and (5) guidelines used by those surveyed. RESULTS: Consultant uro-oncologists from 77% of UK pelvic cancer centers responded, who treated a median of 13 patients per year with NAC before RC. Three cycles of gemcitabine and cisplatin was the most common NAC regimen, with 93% and 67% respondents giving it for downstaging of cN1- and cN2- and 3-positive patients, respectively. Forty-five percent would not give AC after NAC and RC in patients with positive lymph nodes. The patient's performance status, followed by response to NAC were key factors in dictating the use of AC. In the presence of disease progression, 46% of participants would use a taxane. Fifty-two percent of responders do not follow any guidelines. CONCLUSION: In the United Kingdom, the treatment of patients with nodal disease after NAC and RC is variable. There is little evidence on which to base the management of such patients. The creation of national and international guidelines might help clinicians to optimize care for these patients.
INTRODUCTION: Because of the lack of published evidence, this study was done to explore the decisions and rationale of uro-oncology consultants regarding the treatment of patients with muscle-invasive bladder cancer who have positive lymph nodes after radical cystectomy (RC) and neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: An electronic survey was sent to UK pelvic cancer centers regarding: (1) choice of NAC regimen; (2) indications for reimaging; (3) choice and indication of adjuvant chemotherapy (AC) for patients with nodal disease after NAC and RC; (4) choice and indication of chemotherapy regimen if disease continues to progress in patients with advanced bladder cancer; and (5) guidelines used by those surveyed. RESULTS: Consultant uro-oncologists from 77% of UK pelvic cancer centers responded, who treated a median of 13 patients per year with NAC before RC. Three cycles of gemcitabine and cisplatin was the most common NAC regimen, with 93% and 67% respondents giving it for downstaging of cN1- and cN2- and 3-positive patients, respectively. Forty-five percent would not give AC after NAC and RC in patients with positive lymph nodes. The patient's performance status, followed by response to NAC were key factors in dictating the use of AC. In the presence of disease progression, 46% of participants would use a taxane. Fifty-two percent of responders do not follow any guidelines. CONCLUSION: In the United Kingdom, the treatment of patients with nodal disease after NAC and RC is variable. There is little evidence on which to base the management of such patients. The creation of national and international guidelines might help clinicians to optimize care for these patients.
Authors: Felix V Chen; Tulay Koru-Sengul; Feng Miao; Joshua S Jue; Mahmoud Alameddine; Devina J Dave; Sanoj Punnen; Dipen J Parekh; Chad R Ritch; Mark L Gonzalgo Journal: Urol Oncol Date: 2019-08-14 Impact factor: 3.498
Authors: Wilson Sui; Justin T Matulay; Maxwell B James; Ifeanyi C Onyeji; Marissa C Theofanides; Arindam RoyChoudhury; G Joel DeCastro; Sven Wenske Journal: Bladder Cancer Date: 2016-10-27