The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians

Martini, Thomas; Gilfrich, Christian; Mayr, Roman; Burger, Maximilian; Pycha, Armin; Aziz, Atiqullah; Gierth, Michael; Stief, Christian G.; Müller, Stefan C.; Wagenlehner, Florian; Roigas, Jan; Hakenberg, Oliver W.; Roghmann, Florian; Nuhn, Philipp; Wirth, Manfred; Novotny, Vladimir.; Hadaschik, Boris; Grimm, Marc-Oliver; Schramek, Paul; Haferkamp, Axel; Colleselli, Daniela; Kloss, Birgit; Herrmann, Edwin; Fisch, Margit; May, Matthias und Bolenz, Christian (2017): The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians. In: Clinical Genitourinary Cancer, Bd. 15, Nr. 3: S. 356-362

Abstract

Neoadjuvant chemotherapy before radical cystectomy is recommended in patients with bladder cancer in clinical stages T2-T4a, cN0M0. We analyzed the frequency and current practice of neoadjuvant chemotherapy in 679 patients using uni- and multivariable regression analyses and using a questionnaire. We found a great discrepancy between guideline recommendations and practice patterns, despite medical indication and interdisciplinary tumor board discussion. Introduction: Guidelines recommend neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in patients with urothelial carcinoma of the bladder in clinical stages T2-T4a, cN0M0. We examined the frequency and current practice of NAC and sought to identify predictors for the use of NAC in a prospective contemporary cohort. Materials and Methods: We analyzed prospective data from 679 patients in the PROMETRICS (PROspective MulticEnTer Radical Cystectomy Series 2011) database. All patients underwent RC in 2011. Uni- and multivariable regression analyses identified predictors of NAC application. Furthermore, a questionnaire was used to evaluate the practice patterns of NAC at the PROMETRICS centers. Results: A total of 235 patients (35%) were included in the analysis. Only 15 patients (2.2%) received NAC before RC. Younger age (< 70 years;P = .035), lower case volume of the center (< 30 RC/year;P < .001), and advanced tumor stage (>= cT3;P = .038) were identified as predictors for NAC. Of the 200 urologists who replied to the questionnaire, 69% (n = 125) declared tumor stage cT3-4 a/o N1M0 to be the best indication for NAC application, although 45% of the urologists stated that they would not perform NAC despite recommendations. The decision for NAC was made by the individual urologist in 69% of cases, and only 29% reported that all cases were discussed in an interdisciplinary tumor board. Conclusion: NAC was rarely applied in the present cohort. We observed a discrepancy between guideline recommendations and practice patterns, despite medical indication and pre-therapeutic interdisciplinary discussion. The potential benefit of NAC within a multimodal approach seems to be neglected by many urologists.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1558-7673
• Sprache: Englisch