Tracy L Rose1, Allison M Deal2, Ethan Basch1, Paul A Godley1, W Kimryn Rathmell1, William Y Kim1, Young E Whang1, Mary W Dunn3, Andrew Wang4, Ronald C Chen4, Matthew E Nielsen3, Raj S Pruthi3, Eric M Wallen3, Michael E Woods3, Angela B Smith3, Matthew I Milowsky5. 1. Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC. 2. Biostatistics and Clinical Data Management Core, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC. 3. Urologic Oncology Program, Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC. 4. Department of Radiation Oncology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC. 5. Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC. Electronic address: matt_milowsky@med.unc.edu.
Abstract
OBJECTIVES: Neoadjuvant chemotherapy (NAC) before radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). Many patients are referred to an academic medical center (AMC) for cystectomy but receive NAC in the community setting. This study examines if administration of NAC in the community is associated with differences in type of NAC received, pathologic response rate (pT0), and time to cystectomy as compared to NAC administered at an AMC. METHODS: We performed a retrospective study of patients with MIBC (cT2a-T4-Nx-M0) referred to a single AMC between 1/2012 and 1/2014 who received NAC. We analyzed chemotherapy received, time to cystectomy, pT0, and survival in patients who received NAC in our AMC compared to those treated in the community. RESULTS: In all, 47 patients were analyzed. A similar total dose of cisplatin (median: 280 mg/m(2) for both groups, P = 0.82) and pT0 rate (25% vs. 29%, P = 0.72) were seen in patients treated in our AMC and the community. However, administration of NAC in the community was associated with a prolonged time to cystectomy compared with that in our AMC (median number of days 162 vs. 128, P<0.01). This remained significant after adjusting for stage, comorbidity status, and distance to the AMC (P = 0.02). Disease-free survival and overall survival did not differ. CONCLUSION: Patients with MIBC treated with NAC in the community as compared to an AMC received similar chemotherapy and achieved comparable pT0 rates, indicating effective implementation of NAC in the community. However, NAC in the community was associated with longer time to cystectomy, suggesting a delay in the transition of care between settings.
OBJECTIVES: Neoadjuvant chemotherapy (NAC) before radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). Many patients are referred to an academic medical center (AMC) for cystectomy but receive NAC in the community setting. This study examines if administration of NAC in the community is associated with differences in type of NAC received, pathologic response rate (pT0), and time to cystectomy as compared to NAC administered at an AMC. METHODS: We performed a retrospective study of patients with MIBC (cT2a-T4-Nx-M0) referred to a single AMC between 1/2012 and 1/2014 who received NAC. We analyzed chemotherapy received, time to cystectomy, pT0, and survival in patients who received NAC in our AMC compared to those treated in the community. RESULTS: In all, 47 patients were analyzed. A similar total dose of cisplatin (median: 280 mg/m(2) for both groups, P = 0.82) and pT0 rate (25% vs. 29%, P = 0.72) were seen in patients treated in our AMC and the community. However, administration of NAC in the community was associated with a prolonged time to cystectomy compared with that in our AMC (median number of days 162 vs. 128, P<0.01). This remained significant after adjusting for stage, comorbidity status, and distance to the AMC (P = 0.02). Disease-free survival and overall survival did not differ. CONCLUSION:Patients with MIBC treated with NAC in the community as compared to an AMC received similar chemotherapy and achieved comparable pT0 rates, indicating effective implementation of NAC in the community. However, NAC in the community was associated with longer time to cystectomy, suggesting a delay in the transition of care between settings.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: Sarah A Gallagher; Angela B Smith; Jonathan E Matthews; Clarence W Potter; Michael E Woods; Mathew Raynor; Eric M Wallen; W Kimryn Rathmell; Young E Whang; William Y Kim; Paul A Godley; Ronald C Chen; Andrew Wang; Chaochen You; Daniel A Barocas; Raj S Pruthi; Matthew E Nielsen; Matthew I Milowsky Journal: Urol Oncol Date: 2013-02-19 Impact factor: 3.498
Authors: Jeffrey J Tomaszewski; Elizabeth Handorf; Anthony T Corcoran; Yu-Ning Wong; Reza Mehrazin; Justin E Bekelman; Daniel Canter; Alexander Kutikov; David Y T Chen; Robert G Uzzo; Marc C Smaldone Journal: J Urol Date: 2014-05-14 Impact factor: 7.450
Authors: Filipe Lf Carvalho; Alexander Zeymo; Jillian Egan; Colleen H Kelly; Chaoyi Zheng; John H Lynch; Jonathan Hwang; Lambros Stamatakis; Ross E Krasnow; Keith J Kowalczyk Journal: Investig Clin Urol Date: 2020-05-26