Introduction & Objectives
The standard of care regarding the timing of chemotherapy (ct) for locally advanced bladder cancer (BC) remains controversial, as only few randomized studies compared adjuvant versus neoadjuvant ct. The level one evidence supports the use of neoadjuvant ct. We compared patients (pts) outcomes following neoadjuvant or adjuvant ct in unselected pts treated in a routine clinical practice.
Material & Methods
Data from population based cancer registry of Slovenia was used to select a cohort of 116 pts with locally advanced (M0) bladder cancer (BC) consecutively treated between years 2004 through 2008. Patients with metastatic disease (M1) were excluded. Among them, 83 pts were treated with perioperative platinum based ct and radical cystectomy, 18 received radiochemotherapy and 15 had an unexplained early termination of treatment. Clinical data and treatment characteristics were retrospectively collected from medical charts.
Characteristics of pts were as follows: median age: 63 years (range 39-78); stage: II and III 43 (37.1 %), IV (M0) 40 (34.5%); histology: Pure transitional cell carcinoma (TCC) 98 (85%), TCC with aberrant differentation 10 (8%), other 7 (6%). Thirty nine of pts (33.6 %) received neoadjuvant and 44 (37.9%) adjuvant ct, most of them cisplatin (cisplatin/gemcitabine or methotrexate/vinblastine/cisplatin) based regimen (adjuvant: 81.8%, neoadjuvant: 90.9%). Median follow-up was 7.4 years. Five-years DFS for the entire group was 59.8%, mOS 4.7 years (95% CI 2.72-6.81). There was no significant difference in DFS (p=0.68) nor OS (p=0.45) between pts treated with neoadjuvant adjuvant ct.
In our analysis there was no statistically significant difference in survival between pts receiving neoadjuvant versus adjuvant systemic platinum-based ct for locally advanced BC.