NEW YORK (Reuters Health) Jul 27 - In advanced bladder cancer, the timing of chemotherapy -- before surgery, or after -- doesn't affect survival, as long as it's given perioperatively, according to a new paper from New York City.
Lead author Dr. James M. McKiernan told Reuters Health by email, "There is currently no clear cut randomized data that suggest that chemotherapy is better to be given prior to or after radical cystectomy."
He added," From a patient perspective there are several factors that support each approach." With neoadjuvant chemotherapy, for example, adverse effects are experienced before debilitating surgery. Adjuvant chemotherapy may delay treatment, but it may reduce the incidence of local and metastatic recurrence.
Either way, it's clear chemotherapy is helpful. "We sought to evaluate our own experience with each approach to determine if we could identify any superiority between the two practice patterns," Dr. McKiernan said.
With his colleagues at Columbia University Medical Center, he reviewed data on 146 patients who received multiagent platinum-based systemic chemotherapy for locally advanced bladder cancer between 1988 and 2009. Half of them received neoadjuvant chemotherapy; the other half was treated postoperatively.
As reported online June 29th in Cancer, the researchers found no significant difference in overall or disease-specific survival between groups in the 122 patients treated with cisplatin-based protocols (median survival with neoadjuvant vs. adjuvant therapy, 11 vs. 12.5 months, respectively).
This was also true when patients received methotrexate/vinblastine/adriamycin/cisplatin (median survival, 16 vs. 22.2 months).
In addition, there was no significant difference between neoadjuvant and adjuvant cisplatin- or carboplatin-based chemotherapy.
In the 43 patients who received gemcitabine/cisplatin, however, postoperative treatment was associated with significantly reduced survival. The researchers call for further studies to clarify this finding, but they point out that these patients "likely had worse prechemotherapy characteristics including decreased performance status."
Overall, Dr. McKiernan said, "the study concluded that there were no appreciable differences in survival between patients treated with chemotherapy before or after surgery."
This finding should be "considered when counseling patients regarding the sequence of perioperative chemotherapy and should be validated with a prospective randomized trial," he and his colleagues conclude.
SOURCE: http://bit.ly/pqJxCR
Cancer 2011.
Lead author Dr. James M. McKiernan told Reuters Health by email, "There is currently no clear cut randomized data that suggest that chemotherapy is better to be given prior to or after radical cystectomy."
He added," From a patient perspective there are several factors that support each approach." With neoadjuvant chemotherapy, for example, adverse effects are experienced before debilitating surgery. Adjuvant chemotherapy may delay treatment, but it may reduce the incidence of local and metastatic recurrence.
Either way, it's clear chemotherapy is helpful. "We sought to evaluate our own experience with each approach to determine if we could identify any superiority between the two practice patterns," Dr. McKiernan said.
With his colleagues at Columbia University Medical Center, he reviewed data on 146 patients who received multiagent platinum-based systemic chemotherapy for locally advanced bladder cancer between 1988 and 2009. Half of them received neoadjuvant chemotherapy; the other half was treated postoperatively.
As reported online June 29th in Cancer, the researchers found no significant difference in overall or disease-specific survival between groups in the 122 patients treated with cisplatin-based protocols (median survival with neoadjuvant vs. adjuvant therapy, 11 vs. 12.5 months, respectively).
This was also true when patients received methotrexate/vinblastine/adriamycin/cisplatin (median survival, 16 vs. 22.2 months).
In addition, there was no significant difference between neoadjuvant and adjuvant cisplatin- or carboplatin-based chemotherapy.
In the 43 patients who received gemcitabine/cisplatin, however, postoperative treatment was associated with significantly reduced survival. The researchers call for further studies to clarify this finding, but they point out that these patients "likely had worse prechemotherapy characteristics including decreased performance status."
Overall, Dr. McKiernan said, "the study concluded that there were no appreciable differences in survival between patients treated with chemotherapy before or after surgery."
This finding should be "considered when counseling patients regarding the sequence of perioperative chemotherapy and should be validated with a prospective randomized trial," he and his colleagues conclude.
SOURCE: http://bit.ly/pqJxCR
Cancer 2011.
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