ABSTRACT
Purpose: An analysis of neoadjuvant chemotherapy delivery and outcomes for patients with muscle-invasive bladder cancer prior to radical cystectomy. Neoadjuvant chemotherapy is associated with a 5 year 5% overall survival benefit in selected patients [1]. Method(s): Using a central histopathology database, all patients in Northern Ireland with newly diagnosed muscle-invasive bladder cancer between January 2017 and December 2018 were identified. This time period was selected to reflect practice prior to the COVID-19 pandemic. Investigation included MDM discussion rates, number of patients proceeding to neoadjuvant chemotherapy and survival outcomes for all patients. Result(s): 66 patients underwent a radical cystectomy during this time period. 65/66 were discussed at MDM. 39/66 (59%) were reviewed at an oncology clinic and 22/66 (33%) proceeded to neoadjuvant chemotherapy. Reasons for patients not proceeding with neoadjuvant chemotherapy included patient preference (76%), poor renal function (18%) and cardiac history (6%). 10/22 (45%) patients who received neoadjuvant chemotherapy were down-staged at the time of cystectomy showing a complete pathological response. Being reviewed at an oncology clinic for discussion regarding neoadjuvant chemotherapy did not significantly delay time to proceed to surgery if patients opted not to receive chemotherapy. 16/22 (73%) patients who received NAC are alive at the end of follow-up, compared with 25/44 (57%) who did not. There were no SACT-related deaths. Conclusion(s): Our local data show impressive outcomes for patients receiving neoadjuvant chemotherapy. In line with NICE guidelines and published data, we propose that all eligible patients should meet with an oncologist to consider the role of neoadjuvant chemotherapy before proceeding to radical cystectomy. Reference [1] Vale C. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 2003;361(9373):1927-34. Copyright © 2022 The Royal College of Radiologists