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Vol. 45. Issue 4.
Pages 300-308 (May 2021)
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Vol. 45. Issue 4.
Pages 300-308 (May 2021)
Original article
DOI: 10.1016/j.acuroe.2021.03.005
Usefulness of neoadjuvant chemotherapy in non-metastatic muscle-invasive bladder cancer
Utilidad de la quimioterapia neoadyuvante en el carcinoma vesical músculo invasivo no metastásico
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J.A. Esper Ruedaa,
Corresponding author
Jhonatanesper@gmail.com

Corresponding author.
, P. Carrión Lópeza, M.J. Dónate Morenoa, L. Herais Rayaa, I. Díaz de Mera Sánchez Migallóna, O. Legido Gómeza, S. Rico Marcoa, J. Martínez Ruiza, E. Noguerón Martínezb, A.S. Salinas Sáncheza
a Servicio de Urología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
b Servicio de Oncología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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Tables (3)
Table 1. Adverse reactions to systemic treatment, according to NACT protocol.
Table 2. Pre-and post-cystectomy pathological characteristics.
Table 3. Overall survival and progression-free survival times according to pathological factors.
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Abstract
Objective

We analyzed the profile of patients who were candidates for neoadjuvant chemotherapy (NACT) in stage pT2-4aN0M0, the tolerability and adherence of our cisplatin-based protocol and oncological outcomes.

Material and methods

Retrospective observational cohort study including patients diagnosed with muscle-invasive bladder carcinoma treated with NACT. Clinical, histopathological, therapeutic and evolutionary characteristics of the patients were analyzed. The use of NACT was evaluated by the complete response in the surgical specimen (pT0). This and other pathological factors were related to overall survival and progression-free survival.

Results

We included 90 patients with muscle-invasive bladder carcinoma (clinical stage T2a-T4aN0M0) who received a cisplatin-based NACT regimen between January 2011 and December 2018, prior to radical surgery. Forty percent of patients presented an adverse reaction, with a compliance with the NACT regimen of 92.2%. There were no deaths related to systemic treatment and no adverse reaction to treatment made RC impracticable. After performing RC, the presence of complete response (pT0) was observed in 20 patients (21%), lower stage in the surgical specimen (

Conclusion

The adequate selection of patients with MIBC has shown a good tolerance to NACT, with a high compliance rate prior to RC. The improvement in the complete response rate implies a greater survival in this group of patients, with lymph node involvement and positive surgical margins being important prognostic factors.

Keywords:
Bladder cancer
Neoadjuvant chemotherapy
Pathologic complete response
Cisplatin
Survival
Toxicity
Resumen
Objetivo

Analizamos el perfil de pacientes candidatos a quimioterapia neoadyuvante (QTn) en estadio pT2-4aN0M0, la tolerabilidad y adherencia de nuestro protocolo basado en cisplatino y los resultados oncológicos.

Material y métodos

Estudio observacional de cohortes retrospectivo que incluye pacientes con diagnóstico de carcinoma vesical músculo infiltrante, tratados con QTn. Se analizaron las características clínicas, histopatológicas, terapéuticas y evolutivas de los pacientes. El uso de la QTn se evaluó mediante la respuesta completa en la pieza quirúrgica (pT0). Éste y otros factores anatomopatológicos se relacionaron con la supervivencia global y el tiempo libre de progresión.

Resultados

Incluimos 90 pacientes con carcinoma vesical musculo invasivo (Estadio clínico T2a-T4aN0M0) que recibieron algún esquema de QTn basado en cisplatino, entre enero de 2011 y diciembre de 2018, previo al tratamiento quirúrgico radical. El 40% de los pacientes presentaron alguna reacción adversa al tratamiento, con un cumplimiento del protocolo de QTn del 92,2%, No se presentaron muertes relacionadas con el tratamiento sistémico y ninguna reacción adversa al tratamiento imposibilitó la realización de la CR. Tras la realización de CR se objetivó la presencia de respuesta completa (pT0) en 20 pacientes (21%), estadio inferior en pieza quirúrgica (

Conclusión

La selección adecuada de los pacientes con CVMI ha mostrado una buena tolerancia a la QTn, con una alta tasa de cumplimiento previo a la CR. La mejoría en la tasa de respuesta completa implica una mayor supervivencia en este grupo de pacientes, siendo la afectación ganglionar y los bordes quirúrgicos positivos factores pronósticos importantes.

Palabras clave:
Cáncer vesical
Quimioterapia neadyuvante
Respuesta patológica completa
Cisplatino
Supervivencia
Toxicidad

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