17/11/2011
Survival Chances Not Affected by Chemotherapy Before or After Bladder Cancer Surgery
According to a report in the peer-reviewed journal Cancer, in advanced bladder cancer, receiving chemotherapy before or after surgery does not affect survival, as long as it is given perioperatively.
Lead author James M. McKierman, MD, said that there is no clear cut randomized data to suggest that chemotherapy is better to give before or after surgery. With his colleagues at Columbia University Medical Center, McKierman reviewed data on 146 patients who received multiagent platinum-based systemic chemotherapy for locally advanced bladder cancer between 1988 and 2009. Half of them received neoadjuvant chemotherapy, and the other half was treated postoperatively.
The team found no significant difference in overall or disease-specific survival between groups in the 122 patients treated with cisplatin-based protocols. The median survival with neoadjuvant versus adjuvant therapy was 11 months versus 12.5 months, respectively. This was also true when patients received methotrexate/vinblastine/adriamycin/cisplatin (median survival, 16 months versus 22.2 months). Additionally, there was no significant difference between neoadjuvant and adjuvant cisplatin- or carboplatin-based chemotherapy.
There was, however, a significant difference observed in the 43 patients who received gemcitabine/cisplatin. Postoperative treatment for this group was associated with a significantly reduced survival. The team calls for further studies to clarify this finding, but they emphasize that these patients probably had worse pre-chemotherapy characteristics, including decreased performance status.
The study concluded there were no significant differences overall in survival between patients treated with chemotherapy before or after radical cystectomy. Dr. McKiernan that this finding should be “considered when counseling patients regarding the sequence of perioperative chemotherapy and should be validated with a prospective randomized trial.”
