NEW ORLEANS, LA USA (UroToday.com) - Dr. Haseebuddin and group from Fox Chase Cancer Center showed data indicating that neoadjuvant chemotherapy (NAC) has no adverse effect on radical cystectomy (RC) or perioperative complication rates.
Level I evidence showed an improved overall survival with NAC for muscle-invasive bladder cancer. Despite these data, NAC is only utilized in up to 20% of patients. One impediment to its adoption is concern that NAC may increase the complexity of the surgery or increase perioperative complications. To address this concern, the group reviewed the surgical outcomes of patients who underwent NAC followed by RC on two multicenter prospective studies (AMVAC/NCT 01031420; DDGC, NCT01611662) and compared them to a contemporaneous control cohort of patients who underwent RC without NAC. Forty-three patients with muscle-invasive bladder cancer underwent RC after AMVAC, and 30 patients underwent RC after DDGC. Median time to RC was 10 weeks for both cohorts (range: 3-13 weeks AMVAC, 5-29 weeks DDGC). Forty patients underwent RC alone over the same time period. There was no difference in age, EBL, urinary diversion, LN count, and length of stay between NAC-treated patients and controls. NAC patients had higher rate of robotic procedures (p =0.05) and pT0 stage at RC (p =0.03), and lower rate of pT4 stage (p = 0.02) compared to RC alone group.
Overall complication rates were 65.1% (44.1% Grade I/II and 20.9% Grade III-V) in AMVAC group, 70% (43.3% Grade I/II, 26.7% Grade III-V) in DDGC group, and 62.5% (40% Grade I/II, and 22.5% Grade III-V) in control group. There were no differences in complications between AMVAC vs control, DDGC vs control, and AMVAC + DDGC vs control groups.
In conclusion, NAC does not increase surgical complexity, as measured by operative parameters, nor does it increase perioperative complication rates. Surgical approach and perioperative RC outcomes are unaffected by the receipt of NAC, and concerns over compromise of RC by NAC are unfounded.
Presented and reported by Mohammed Haseebuddin, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Fox Chase Cancer Center, Philadelphia, PA USA