A study on effect of neoadjuvant chemotherapy on peri operative complications and outcome in patients under-going radical cystectomy for muscle invasive bladder cancer
DOI:
https://doi.org/10.18203/2320-6012.ijrms20184033Keywords:
Bladder cancer, Complications, Neoadjuvant chemotherapy, Radical cystectomyAbstract
Background: To compare the peri-operative complications, related to radical cystectomy and to compare peri operative outcomes between patients receiving neoadjuvant chemotherapy and those treated with radical cystectomy alone.
Methods: This was prospective observational study. The study was conducted at ‘The Department of Urosurgery, R. G. Kar Medical College and Hospital, Kolkata’. Study period was between March 2016 to March 2018. Total 36 patients were included in present study. Patients after clinical diagnosis and risk factor profile analysis were divided into two groups: (1) radical cystectomy alone (n=24) (2) patients received neoadjuvant chemotherapy (gemcitabine and cisplatin regime) followed by radical cystectomy (n=12). Different parameters were compared.
Results: Total 36 patients were underwent radical cystectomy. In group 1, 96% (n=23) were having T2 stage while 4% (n=1) were having T3stage. In group 2 25% (n=3) patients were having T2stage while 75% (n=9) were having T3 stage as per CECT staging. There were no significant difference noted in perioperative complications in both groups except perioperative adhesions (group 2, 47% vs group 1, 8.3%). There was significant time delay in radical cystectomy in group 2 (patients received neoadjuvant chemotherapy).
Conclusions: We found there were no significant increase in perioperative morbidity and mortality with Neoadjuvant Chemotherapy. Most of the complications were comparable to previous studies.
Metrics
References
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11-30.
BITE S. Probability of Developing Invasive Cancers Over Selected Ages, 2000-2002. J National Cancer Institute. 2006 Jun 21;98(12).
Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk MA, Merseburger AS, et al. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. European urology. 2009 Apr 1;55(4):815-25.
Meeks JJ, Bellmunt J, Bochner BH, Clarke NW, Daneshmand S, Galsky MD, et al. A systematic review of neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer. European urology. 2012 Sep 1;62(3):523-33.
Sternberg CN, Bellmunt J, Sonpavde G, Siefker-Radtke AO, Stadler WM, Bajorin DF, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: chemotherapy for urothelial carcinoma-neoadjuvant and adjuvant settings. European urology. 2013 Jan 1;63(1):58-66.
Sternberg CN, Yagoda A, Scher HI, Watson RC, Ahmed T, Weiselberg LR, et al. Preliminary results of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for transitional cell carcinoma of the urothelium. J Urology. 1985 Mar 1;133(3):403-7.
Millikan R, Dinney C, Swanson D, Sweeney P, Ro JY, Smith TL, et al. Integrated therapy for locally advanced bladder cancer: final report of a randomized trial of cystectomy plus adjuvant M-VAC versus cystectomy with both preoperative and postoperative M-VAC. J Clin Oncol. 2001 Oct 15;19(20):4005-13.
Sternberg CN. Neo-adjuvant and adjuvant chemotherapy of bladder cancer: is there a role? Ann Oncol. 2002;13(Suppl. 4):273-9.
Sternberg CN. Neoadjuvant and adjuvant chemotherapy in locally advanced bladder cancer. Semin Oncol. 1996;23:621-32
Chang SS, Hassan JM, Cookson MS, Wells N, Smith JA Jr. Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. J Urol. 2003;170:1085-7.
Apolo AB, Grossman HB, Bajorin D, Steinberg G, Kamat AM. Practical use of perioperative chemotherapy for muscle-invasive bladder cancer: summary of session at the Society of Urologic Oncology annual meeting. InUrologic Oncology: Seminars and Original Investigations 2012 Nov 1 (Vol. 30, No. 6, pp. 772-780). Elsevier.
Dash A, Pettus IV JA, Herr HW, Bochner BH, Dalbagni G, Donat SM, et al. A role for neoadjuvant gemcitabine plus cisplatin in muscle‐invasive urothelial carcinoma of the bladder: a retrospective experience. Cancer. 2008 Nov 1;113(9):2471-7.
Johnson DC, Nielsen ME, Matthews J, Woods ME, Wallen EM, Pruthi RS, et al. Neoadjuvant chemotherapy for bladder cancer does not increase risk of perioperative morbidity. BJU international. 2014 Aug;114(2):221-8.
Gandaglia G, Popa I, Abdollah F, Schiffmann J, Shariat SF, Briganti A, et al. The effect of neoadjuvant chemotherapy on perioperative outcomes in patients who have bladder cancer treated with radical cystectomy: a population-based study. European urology. 2014 Sep 1;66(3):561-8.
Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tobacco control. 2003 Dec 1;12(4):e4-.
Vale CA. Advanced Bladder Cancer (ABC). Meta-analysis Collaboration. Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data. Eur Urol. 2005;48:189-201.
European Health Interview Survey (EHIS). Overweight and obesity-BMI statistics. Available at: http://ec.europa.eu/eurostat/statistics-explained/ index.php/Overweight_and_obesity_-_BMI_ statistics. Accessed on 14th Jan 2018.
Guzzo TJ, Vaughn DJ. Management Of metastatic and invasive bladder cancer. In: Wein AJ, Facs (Ed.). Campbell Walsh Urology. 11th ed. Philadelphia: Elsevier;2016:2231.
Hall MC, Swanson DA, Dinney CP. Complications of radical cystectomy: impact of the timing of perioperative chemotherapy. Urology. 1996 Jun 1;47(6):826-30.
Stockle M, Meyenburg W, Wellek S, Voges GE, Rossmann M, Gertenbach U, et al. Adjuvant polychemotherapy of nonorgan-confined bladder cancer after radical cystectomy revisited: long-term results of a controlled prospective study and further clinical experience. J Urology. 1995 Jan 1;153(1):47-52.
Picchio M, Treiber U, Beer AJ, Metz S, Bössner P, van Randenborgh H, et al. Value of 11C-choline PET and contrast-enhanced CT for staging of bladder cancer: correlation with histopathologic findings. J Nuclear Medicine. 2006;47(6):938-44.