Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it?
Abstract. Background. Compliance with the guideline recommendations for neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer is incomplete. The adjuvant chemotherapy approach has the advantage of pathology-based decision-making, allowing for patient selection. In addition, radica...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2023-06-01
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| Series: | Current Urology |
| Online Access: | http://journals.lww.com/10.1097/CU9.0000000000000099 |
| _version_ | 1797671817855369216 |
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| author | Roy Croock Jonathan Modai Yuval Avda Igal Shpunt Morad Jaber Yamit Peretz Yaniv Shilo Dan Leibovici |
| author_facet | Roy Croock Jonathan Modai Yuval Avda Igal Shpunt Morad Jaber Yamit Peretz Yaniv Shilo Dan Leibovici |
| author_sort | Roy Croock |
| collection | DOAJ |
| description | Abstract. Background. Compliance with the guideline recommendations for neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer is incomplete. The adjuvant chemotherapy approach has the advantage of pathology-based decision-making, allowing for patient selection. In addition, radical surgery is not delayed and treatment-related toxicity does not impair surgical fitness. The proportion of patients who completed chemotherapy after cystectomy among those who were fit and in need of treatment were evaluated. The reasons for not completing adjuvant chemotherapy were determined.
Materials and methods. We retrospectively evaluated all patients who had undergone radical cystectomy at our center over the last 7 years. Indications for adjuvant chemotherapy included pathological T > 2, any node+, or surgical margin involvement. Only patients who were fit for chemotherapy before surgery were included in the study.
Results. Of the 52 patients with muscle-invasive bladder cancer, 14 received neoadjuvant chemotherapy or unfit for chemotherapy were excluded. Of the remaining 38 patients, 14 (37%) had bladder-confined cancers and did not require additional chemotherapy. Of the 24 patients who needed chemotherapy and were fit to receive it, 8 patients completed treatment (33%), and 3 discontinued treatment due to toxicity. Twelve patients (50%) declined chemotherapy, whereas 1 patient became unfit for chemotherapy after surgery.
Conclusions. While the adjuvant chemotherapy approach could save unnecessary treatment in 37% of patients, two-thirds of those who needed chemotherapy did not complete it. Patient refusal was the primary reason for not receiving treatment. |
| first_indexed | 2024-03-11T21:21:00Z |
| format | Article |
| id | doaj.art-8238cc9ecb234c01a0917f8c53e0ebf2 |
| institution | Directory Open Access Journal |
| issn | 1661-7649 |
| language | English |
| last_indexed | 2024-03-11T21:21:00Z |
| publishDate | 2023-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Current Urology |
| spelling | doaj.art-8238cc9ecb234c01a0917f8c53e0ebf22023-09-28T07:07:38ZengWolters Kluwer HealthCurrent Urology1661-76492023-06-0117210911210.1097/CU9.0000000000000099202306000-00007Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it?Roy Croock0Jonathan Modai1Yuval Avda2Igal Shpunt3Morad Jaber4Yamit Peretz5Yaniv Shilo6Dan Leibovici7Department of Urology, Kaplan Medical Center, Rehovot, IsraelDepartment of Urology, Kaplan Medical Center, Rehovot, IsraelDepartment of Urology, Kaplan Medical Center, Rehovot, IsraelDepartment of Urology, Kaplan Medical Center, Rehovot, IsraelDepartment of Urology, Kaplan Medical Center, Rehovot, IsraelDepartment of Urology, Kaplan Medical Center, Rehovot, IsraelDepartment of Urology, Kaplan Medical Center, Rehovot, IsraelDepartment of Urology, Kaplan Medical Center, Rehovot, IsraelAbstract. Background. Compliance with the guideline recommendations for neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer is incomplete. The adjuvant chemotherapy approach has the advantage of pathology-based decision-making, allowing for patient selection. In addition, radical surgery is not delayed and treatment-related toxicity does not impair surgical fitness. The proportion of patients who completed chemotherapy after cystectomy among those who were fit and in need of treatment were evaluated. The reasons for not completing adjuvant chemotherapy were determined. Materials and methods. We retrospectively evaluated all patients who had undergone radical cystectomy at our center over the last 7 years. Indications for adjuvant chemotherapy included pathological T > 2, any node+, or surgical margin involvement. Only patients who were fit for chemotherapy before surgery were included in the study. Results. Of the 52 patients with muscle-invasive bladder cancer, 14 received neoadjuvant chemotherapy or unfit for chemotherapy were excluded. Of the remaining 38 patients, 14 (37%) had bladder-confined cancers and did not require additional chemotherapy. Of the 24 patients who needed chemotherapy and were fit to receive it, 8 patients completed treatment (33%), and 3 discontinued treatment due to toxicity. Twelve patients (50%) declined chemotherapy, whereas 1 patient became unfit for chemotherapy after surgery. Conclusions. While the adjuvant chemotherapy approach could save unnecessary treatment in 37% of patients, two-thirds of those who needed chemotherapy did not complete it. Patient refusal was the primary reason for not receiving treatment.http://journals.lww.com/10.1097/CU9.0000000000000099 |
| spellingShingle | Roy Croock Jonathan Modai Yuval Avda Igal Shpunt Morad Jaber Yamit Peretz Yaniv Shilo Dan Leibovici Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it? Current Urology |
| title | Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it? |
| title_full | Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it? |
| title_fullStr | Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it? |
| title_full_unstemmed | Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it? |
| title_short | Adjuvant chemotherapy after radical cystectomy: Do all patients who need chemotherapy after surgery actually receive it? |
| title_sort | adjuvant chemotherapy after radical cystectomy do all patients who need chemotherapy after surgery actually receive it |
| url | http://journals.lww.com/10.1097/CU9.0000000000000099 |
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