Filip Grubišić-Čabo, Robert Grubišić-Čabo,
General hospital Šibenik
Radical cystectomy and bilateral pelvic lymphadenectomy remains the most important treatment for patients with nonmetastatic transitional cell muscle-invasive bladder cancer! But despite radical surgery some 50% of patients, with cancer stage T2-T4, will with the time develop metastasis and generally as a consequence of this relaps die! Perioperative treatment can be delivered in a neoadjuvant or adjuvant form. For the past 10-15 years it has been quite clear that neoadjuvant systemic therapy with cisplatin-based chemotherapy, prior to cystectomy, improves median survival by approximately 3 years when compared to cystectomy alone. It improves disease free survival, as well as overall survival.
Despite that less than 20% of patients undergoing radical cystectomy recieve neoadjuvant chemotherapy (1). Probably this relates to complex interaction between physician knowledge, belifes, atitudes as well as patient preferences. This issue is a perfect example of the disconnect between the efficacy of an intervention as studied in the context of a clinical trial, and its efficacy when applied to real-world patients. Has the time come to change this practice?
1) Raj GV, Karavadia S, Schmoler B, et al. Contemporary use of perioperative cisplatin-based chemotherapy in patients with muscle-invasive bladder cancer. Cancer 2011;117:276.