Comparison between neoadjuvant and adjuvant gemcitabine plus cisplatin chemotherapy for muscle-invasive bladder cancer.

Abstract

AIM:

Radical cystectomy plus platinum-based perioperative chemotherapy is a standard treatment for patients with clinically localized muscle-invasive bladder cancer. The standard perioperative chemotherapy is methotrexate, vinblastine, doxorubicin and cisplatin (MVAC). However, no prospective randomized trial has been published that compares neoadjuvant and adjuvant chemotherapy for bladder cancer. Moreover, the efficacy of perioperative chemotherapy with gemcitabine plus cisplatin (GC) has not been clarified. In this study we have compared the clinical outcomes between neoadjuvant and adjuvant chemotherapy in patients receiving GC.

METHODS:

We retrospectively reviewed the records of patients who were scheduled to be treated with a radical cystectomy plus perioperative chemotherapy with GC from 2005 to 2010 at our institution. The primary outcome measure was recurrence-free survival (RFS).

RESULTS:

A total of 42 patients received perioperative chemotherapy with GC (25 neoadjuvant, 17 adjuvant). The median number of cycles of GC administered to the two groups was not significantly different. The median duration of follow up was 28.6 months. During the follow-up period, recurrence was observed in nine and three patients in the neoadjuvant and adjuvant groups, respectively. The RFS rate at median follow up was 67 and 76% in the neoadjuvant and adjuvant groups, respectively. No significant difference in RFS at median follow up was observed between the two groups (P = 0.124).

CONCLUSION:

Our results showed no statistically significant difference in RFS between neoadjuvant and adjuvant GC chemotherapy for muscle-invasive bladder cancer. We expect to validate these findings in a prospective randomized trial.

• Authors: Nobuaki Matsubara, Hirofumi Mukai, Yoichi Naito, Masahiko Nezu, Kuniaki Itoh
• Journal: Asia-Pacific journal of clinical oncology (Asia Pac J Clin Oncol) Vol. 9 Issue 4 Pg. 310-7 (Dec 2013) ISSN: 1743-7563 [Electronic] Australia
• PMID: 23127231 (Publication Type: Journal Article)
• Copyright: © 2012 The Authors. Asia-Pacific Journal of Clinical Oncology published by Wiley Publishing Asia Pty Ltd.

Chemical References

• Deoxycytidine
• Cisplatin
• Gemcitabine

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Chemotherapy, Adjuvant
• Cisplatin (administration & dosage, adverse effects)
• Cystectomy
• Deoxycytidine (administration & dosage, adverse effects, analogs & derivatives)
• Female
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Invasiveness
• Randomized Controlled Trials as Topic
• Retrospective Studies
• Treatment Outcome
• Urinary Bladder Neoplasms (drug therapy, pathology, surgery)
• Gemcitabine