INTRODUCTION:Despite an aggressive initial treatment, only 60% of patients with T2-staged bladder tumours, 50% with T3a and 15% with T3b staged-tumours will be alive at 5 years.
The purpose of this review is to clarify the potential role of chemotherapy in localised urothelial tumours, which has not been clearly defined.
MATERIALS AND METHODS: To address this question, we reviewed published randomized trials of chemotherapy in urothelial tumours of the bladder in both neoadjuvant and adjuvant settings from 1980 and 2010 and corresponding meta-analyses in PubMed.
RESULTS: In the neoadjuvant setting, a meta-analysis of individual data from 3005 patients demonstrated an absolute survival benefit of 5.5% at 5 years. Despite these results, neoadjuvant chemotherapy is very rarely proposed in this indication. Comparative trials performed in the adjuvant setting have been limited by major methodological weaknesses, preventing definitive conclusions. In a meta-analysis based on individual data from 491 patients, a 25% reduction in death risk was observed for an absolute gain of 9% at 3 years.
CONCLUSION: In light of these data, chemotherapy should be offered early and proposed as a reasonable option for patients for tumours with extravesical extension or with nodal involvement detected postoperatively, neoadjuvant chemotherapy is the standard of care.
Written by:
Houédé N, Beuzeboc P, Culine S, Soulié M, Pfister C. Are you the author?
Département d'oncologie médicale, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
Reference: Prog Urol. 2012 Mar;22(3):139-45.
doi: 10.1016/j.purol.2011.09.010
PubMed Abstract
PMID: 22364623
Article in French.
