MP67-07 NEOADJUVANT CHEMOTHERAPY (NAC) HAS NO ADVERSE EFFECT ON RADICAL CYSTECTOMY (RC) OR PERIOPERATIVE COMPLICATIONS. (2015)

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2015MP67-07 NEOADJUVANT CHEMOTHERAPY (NAC) HAS NO ADVERSE EFFECT ON RADICAL CYSTECTOMY (RC) OR PERIOPERATIVE COMPLICATIONS. Mohammed Haseebuddin, Reza Mehrazin, Edouard Trabulsi, Karthik Devarajan, Yu-Ning Wong, Jean Hoffman-Censits, Costas Lallas, Rosalia Viterbo, Alexander Kutikov, Marc Smaldone, Richard Greenberg, Robert Uzzo, Elizabeth Plimack, and David Chen Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Karthik DevarajanKarthik Devarajan More articles by this author , Yu-Ning WongYu-Ning Wong More articles by this author , Jean Hoffman-CensitsJean Hoffman-Censits More articles by this author , Costas LallasCostas Lallas More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Elizabeth PlimackElizabeth Plimack More articles by this author , and David ChenDavid Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2490AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Level 1 evidence shows an improved overall survival with NAC for patients with ≥T2 bladder cancer (BC). Despite these data, NAC use in the United States is low. One impediment to its adoption is the concern that NAC may increase the morbidity of definitive surgery. To address this question, we reviewed the surgical outcomes of patients who underwent NAC followed by RC on two multi-center prospective studies compared to a control cohort of patients who underwent RC without NAC. METHODS The peri-operative course of patients treated on two sequential prospective multicenter phase II studies conducted at FCCC/TJU between 2010 and 2013 with either Accelerated methotrexate, vinblastine, doxorubicin, cisplatin (AMVAC, NCT01031420) or Dose-dense gemcitabine, cisplatin (DDGC, NCT01611662) chemo in the neoadjuvant setting followed by RC was abstracted and compared to a contemporaneous cohort who underwent RC alone. Surgical parameters including type of procedure, urinary diversion, estimated blood loss (EBL), Lymph Node (LN) yield, pathological T stage, length of stay (LOS) were measured. Perioperative complications were captured and graded using the standardized Clavien-Dindo classification and compared using the Chi-square tests. RESULTS 43 ≥T2 BC patients underwent RC after AMVAC, and 30 ≥T2 BC patients underwent RC after DDGC; median time to RC was 10 weeks for both cohorts (range: 3-13 weeks AMVAC, 5-29 weeks DDGC). 40 patients underwent RC alone over the same time period. There was no difference in age, EBL, urinary diversion, LN count, and LOS between NAC treated patients and controls. NAC patients had higher rate of robotic procedures (p =0.05) and pT0 stage at RC (p =0.03), and lower rate of pT4 stage (p = 0.02) compared to RC alone group. Overall complication rates were 65.1% (44.1% Grade I/II and 20.9% Grade III-V) in AMVAC group, 70% (43.3% Grade I/II, 26.7% Grade III-V) in DDGC group, and 62.5% (40% Grade I/II, and 22.5% Grade III-V) in control group. There were no differences in Grade I-II or Grade III-V complication rates between AMVAC vs control (p =0.87, p = 1 respectively), DDGC vs control (p = 0.97, p = 0.9), and AMVAC + DDGC vs control (p = 0.85, p= 1). CONCLUSIONS NAC does not increase surgical complexity, as measured by operative parameters, nor does it increase perioperative complication rates. Surgical approach and perioperative RC outcomes are unaffected by receipt of NAC, and concerns over compromise of RC by NAC are unfounded. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e852 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammed Haseebuddin More articles by this author Reza Mehrazin More articles by this author Edouard Trabulsi More articles by this author Karthik Devarajan More articles by this author Yu-Ning Wong More articles by this author Jean Hoffman-Censits More articles by this author Costas Lallas More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Richard Greenberg More articles by this author Robert Uzzo More articles by this author Elizabeth Plimack More articles by this author David Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...