The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians

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.

Clinical genitourinary cancer. 2016 Sep 19 [Epub ahead of print]

Thomas Martini, Christian Gilfrich, Roman Mayr, Maximilian Burger, Armin Pycha, Atiqullah Aziz, Michael Gierth, Christian G Stief, Stefan C Müller, Florian Wagenlehner, Jan Roigas, Oliver W Hakenberg, Florian Roghmann, Philipp Nuhn, Manfred Wirth, Vladimir Novotny, Boris Hadaschik, Marc-Oliver Grimm, Paul Schramek, Axel Haferkamp, Daniela Colleselli, Birgit Kloss, Edwin Herrmann, Margit Fisch, Matthias May, Christian Bolenz

Department of Urology, University of Ulm, Ulm, Germany. Electronic address: ., Department of Urology, Urologische Klinik, Klinikum St. Elisabeth Straubing, Straubing, Germany., Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany., Department of Urology, General Hospital of Bolzano, Bolzano, Italy., Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany., Department of Urology, Klinik Und Poliklinik Für Urologie Und Kinderurologie, Bonn, Germany., Department of Urology, Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany., Department of Urology, Vivantes Medical Centre Im Friedrichshain and Am Urban, Berlin, Germany., Department of Urology, University Hospital Rostock, Rostock, Germany., Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany., Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany., Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany., Department of Urology, University Hospital Heidelberg, Heidelberg, Germany., Department of Urology, University Hospital of Jena, Jena, Germany., Department of Urology, Hospital Saint John of God Vienna, Vienna, Austria., Department of Urology, Johannes Gutenberg University, Mainz, Germany., Department of Urology, Paracelsus Medical University, Salzburg, Austria., Department of Urology, University of Münster, Münster, Germany., Department of Urology, University of Ulm, Ulm, Germany. Electronic address: .