Muscle Invasive Bladder Cancer: To Cystectomise or Not? The Role of Neoadjuvant Chemotherapy

Goonewardene S, Bhal A and Persad R

The Royal Free and University College London, London
North Bristol NHS Trust, London

^*Correspondance to: Raj Persad 

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Abstract:

Background: Bladder cancer is one of the most common cancers in the western world with associated significant mortality. Once proven to be muscle invasive, radical therapy is required. Neoadjuvant chemotherapy prior to radical treatment has been present for at least three decades.
Objective: We review the literature associated with clinical and cost effectiveness related to neoadjuvant chemotherapy for muscle invasive bladder cancer.
Design: literature review Setting/ Participants/ Intervention: none applicable. Outcomes Measures: papers related to search terms of neoadjuvant chemotherapy, muscle invasive bladder cancer, clinical and cost effectiveness.
Results: From the literature review, the benefits of neoadjuvant chemotherapy for muscle invasive bladder cancer are wide ranging. This includes a greatly improved response rate including compete response and improved survival rate. Potential disadvantages of NAC include less accurate staging, delay in curative surgery (risk greater if delay > 12 weeks) in none-responders and a well-known fact that none responders will fare worse later on. Conclusions: In conclusion neoadjuvant chemotherapy followed by radical therapy is the gold standard for muscle invasive bladder tumours for patients sufficiently fit despite cost effectiveness. As yet, this intervention has not been examined by NICE. However, there are many unanswered questions. Patient summary: Whilst neoadjuvant chemotherapy remains the gold standard therapy for muscle invasive bladder cancer, it has not yet been approved by NICE, and a number of questions are raised.

Keywords:

Muscle invasive bladder cancer; Neoadjuvant chemotherapy; Clinical effectiveness; Cost effectiveness

Cite the Article:

Goonewardene S, Bhal A, Persad R. Muscle Invasive Bladder Cancer: To Cystectomise or Not? The Role of Neoadjuvant Chemotherapy. Clin Oncol. 2016; 1: 1045.