Martini, Thomas and Gilfrich, Christian and Mayr, Roman and Burger, Maximilian and Pycha, Armin and Aziz, Atiqullah and Gierth, Michael and Stief, Christian G. and Mueller, Stefan C. and Wagenlehner, Florian and Roigas, Jan and Hakenberg, Oliver W. and Roghmann, Florian and Nuhn, Philipp and Wirth, Manfred and Novotny, Vladimir. and Hadaschik, Boris and Grimm, Marc-Oliver and Schramek, Paul and Haferkamp, Axel and Colleselli, Daniela and Kloss, Birgit and Herrmann, Edwin and Fisch, Margit and May, Matthias and Bolenz, Christian (2017) The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians. CLINICAL GENITOURINARY CANCER, 15 (3). pp. 356-362. ISSN 1558-7673, 1938-0682
Full text not available from this repository. (Request a copy)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. (C) 2016 Elsevier Inc. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CISPLATIN-BASED CHEMOTHERAPY; RADICAL CYSTECTOMY; PERIOPERATIVE CHEMOTHERAPY; ADJUVANT CHEMOTHERAPY; CANCER; ELIGIBILITY; TRENDS; Guideline recommendation; Muscle-invasive bladder cancer; Questionnaire; Radical cystectomy; Tumor board |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:10 |
| Last Modified: | 28 Feb 2019 10:24 |
| URI: | https://pred.uni-regensburg.de/id/eprint/745 |
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