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What is the role of adjuvant chemotherapy in locally advanced and lymph node-positive bladder cancer after radical cystectomy
Indian Journal of Urology, 06/26/09

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

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