Hans, M.G. (2012) Neoadjuvante chemotherapie voor het spierinvasief urotheelcelcarcinoom van de blaas:een landelijke inventarisatie en resultaten uit het Erasmus MC. thesis, Medicine.
Full text available on request.Abstract
Background: Radical cystectomy is the standard treatment for muscle-invasive urothelial bladder cancer. Over the last few years multiple trials have shown a survival benefit for patients treated with neoadjuvant chemotherapy and radical cystectomy or radiotherapy compared to radical cystectomy or radiotherapy alone. The aim of this study was to compare clinical and pathologic outcomes of patients treated with neoadjuvant chemotherapy and cystectomy versus cystectomy alone in a tertiary referral center. In addition, an inventory was made addressing the use of neoadjuvant chemotherapy in the Netherlands. Methods: We retrospectively analyzed all patients with a clinical staged T2-T4N0-N1M0 urothelial bladder cancer, who had a cystectomy between March 2007 and June 2012. Primary outcome was pathologic downstaging at cystectomy (defined as pathologic TNM less than clinical TNM). In addition the clinical response after neoadjuvant chemotherapy was evaluated according to RECIST criteria. Questionnaires were sent to all teaching hospitals for the inventory of the use of neoadjuvant chemotherapy in the Netherlands. Results: Seventy-eight patients were analyzed, 57 patients were treated with cystectomy alone, 21 patients were treated with neoadjuvant chemotherapy followed by cystectomy. Pathologic downstaging rates were higher in patients receiving neoadjuvant chemotherapy and cystectomy compared to patients receiving cystectomy alone. Complete downstaging rate was significantly increased in patients treated with neoadjuvant chemotherapy (P = 0,026). Clinical response for patients treated with neoadjuvant chemotherapy showed that 33% had a partial response, 62% had stable disease and 5% had progressive disease. Only 25% of the teaching hospitals considered neoadjuvant chemotherapy for the treatment of muscle-invasive bladder cancer. In most hospitals, the estimated percentage of patients starting with neoadjuvant chemotherapy was less than 10%. The majority of hospitals prescribed 3 or 4 cycles of the combination of gemcitabin/cisplatin as the regimen of choice for neoadjuvant chemotherapy. Conclusion: Neoadjuvant cisplatin-based chemotherapy plus cystectomy for patients with muscle-invasive urothelial cancer of the bladder resulted in a better pathologic outcome compared to treatment with cystectomy alone. Despite level I evidence that is in favour of neoadjuvant chemotherapy for the treatment of muscle-invasive bladder cancer, the use of neoadjuvant chemotherapy in the Netherlands is still low.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Boerma, Drs. M.O. and Afdeling Urologie and Deventer Ziekenhuis |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/396 |
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