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Forschungsdatenbank PMU-SQQUID

The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians.
Martini, T; Gilfrich, C; Mayr, R; Burger, M; Pycha, A; Aziz, A; Gierth, M; Stief, CG; Muller, SC; Wagenlehner, F; Roigas, J; Hakenberg, OW; Roghmann, F; Nuhn, P; Wirth, M; Novotny, V; Hadaschik, B; Grimm, MO; Schramek, P; Haferkamp, A; Colleselli, D; Kloss, B; Herrmann, E; Fisch, M; May, M; Bolenz, C
CLIN GENITOURIN CANC. 2017; 15(3): 356-362.
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Colleselli Daniela
Kloss Birgit

Abstract

INTRODUCTION
Guidelines recommend neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in patients with urothelial carcinoma of the bladder in clinical stages T2-T4a, cN0M0. We examined the frequency and current practice of NAC and sought to identify predictors for the use of NAC in a prospective contemporary cohort.
We analyzed prospective data from 679 patients in the PROMETRICS (PROspective MulticEnTer RadIcal Cystectomy Series 2011) database. All patients underwent RC in 2011. Uni- and multivariable regression analyses identified predictors of NAC application. Furthermore, a questionnaire was used to evaluate the practice patterns of NAC at the PROMETRICS centers.
A total of 235 patients (35%) were included in the analysis. Only 15 patients (2.2%) received NAC before RC. Younger age (< 70 years; P = .035), lower case volume of the center (< 30 RC/year; P < .001), and advanced tumor stage (≥ cT3; P = .038) were identified as predictors for NAC. Of the 200 urologists who replied to the questionnaire, 69% (n = 125) declared tumor stage cT3-4 a/o N1M0 to be the best indication for NAC application, although 45% of the urologists stated that they would not perform NAC despite recommendations. The decision for NAC was made by the individual urologist in 69% of cases, and only 29% reported that all cases were discussed in an interdisciplinary tumor board.
NAC was rarely applied in the present cohort. We observed a discrepancy between guideline recommendations and practice patterns, despite medical indication and pre-therapeutic interdisciplinary discussion. The potential benefit of NAC within a multimodal approach seems to be neglected by many urologists.


Find related publications in this database (Keywords)

Guideline recommendation
Muscle-invasive bladder cancer
Questionnaire
Radical cystectomy
Tumor board