What is the role of adjuvant chemotherapy in locally advanced and lymph node-positive bladder cancer after radical cystectomy
Maheshwari R et al. - Study concludes that adjuvant chemotherapy does not improve either cancer specific survival (CSS) or overall survival (OS) in high-risk bladder cancer patients. Methods- Aim was to investigte if pts with pathologically staged tumors with evidence of metastatic disease may benefit from systemic therapy
- Within a study group of 958 pts treated with radical cystectomy (RC), 274 (29.0%) pts with a high risk of progression were identified
- Of these, 129 (46.6%) received adjuvant chemotherapy (ACHT):
- 103 pts received Methotrexate, Vincristine, Adriamycin, Cyclophosphamide (MVAC)
- 26 pts received Gemcetabine and Cis-platin (GC)
- These pts were then matched with the remaining pts who were unexposed to ACHT
- Exact matches were made for age year of surgery, pT stage, tumor grade, pN stage and lymphovascular invasion (LVI)
Results- Median f/u in event-free pts was 2.4 yrs; cancer-specific mortality was documented in 115 pts (41.5%)
- Median actuarial CSS: 5.3 yrs; in the overall cohort, the mean CSS probabilities were 64.2, 51.3, and 37.7% respectively, at 2, 5 and 10 yrs after RC
- Median actuarial OS was 3.7 yrs ; OS probabilities were 60.7, 44.9 and 25.9%, respectively, at 2, 5 and 10 yrs after RC in the overall cohort
- No difference in age, year of surgery, tumor grade, tumor stage, rate of LVI, and rate of lymph node invasion between the groups
- CSS and OS were not different between the overall cohort and the matched cohort
- No difference in CSS or in OS between the groups
- No difference in the CSS or in the OS between the 2 ACHT regimens
[more...]
|
|
|
