Multi-institutional quality-of-care initiative for nonmetastatic, muscle-invasive, transitional cell carcinoma of the bladder: Phase I.

Author:

Feifer A.1,Taylor J. M.1,Shouery M.1,Steinberg G. D.1,Stadler W. M.1,Schoenberg M.1,Zlotta A.1,Lerner S. P.1,Bajorin D. F.1,Bochner B.1,

Affiliation:

1. Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Chicago, Chicago, IL; The University of Chicago Medical Center, Chicago, IL; Johns Hopkins Medical Institutions, Baltimore, MD; Princess Margaret Hospital, Toronto, ON, Canada; Baylor College of Medicine, Houston, TX

Abstract

240 Background: Evidence supports multimodality treatment for muscle invasive bladder cancer [MIBC] with the strongest evidence (level 1) existing for cisplatin-based neoadjuvant chemotherapy. Although reflected in guidelines for the management of MIBC, little is known about the variation of actual practice patterns among academic institutions. We thus evaluated treatment variation among 14 academic centers in the management of patients with MIBC. Methods: Retrospective data were collected for centralized analysis. All patients who underwent radical cystectomy for clinical T2-4 N0M0 MIBC from 2003–2008 were eligible for inclusion. Specific endpoints for analysis included: rates of neoadjuvant and adjuvant therapy, cisplatin use, number of cycles and rates of pelvic lymphadenectomy. Results: 14 institutions participated and data on 4,541 patients who met inclusion criteria were tabulated. Overall 34% of patients received perioperative chemotherapy. The overall use of neoadjuvant and adjuvant therapy was 12% and 22%, respectively. In a subset analysis of those patients with specific chemotherapy agent information provided (n=3,120), 59% of patients managed with perioperative chemotherapy received cisplatin. Of those who received treatment in the neoadjuvant setting, cisplatinum was received in 65% of cases (supported by level 1 evidence). 80% of patients who received perioperative chemotherapy received at least 3 cycles. At radical cystectomy 95% of patients received a bilateral PLND. Conclusions: In this cohort of academic North American centers, 66% of potentially eligible bladder cancer patients undergoing radical cystectomy did not receive perioperative chemotherapy. Only 12% of patients received neoadjuvant chemotherapy, and 35% of those patients received a non-cisplatin based regimens. Despite level 1 evidence that cisplatin based neoadjuvant chemotherapy is associated with a survival advantage, only a small percentage of eligible patients undergoing radical cystectomy for muscle invasive, resectable disease receive combined treatment. Further study is needed clarify specific reasons for the treatment variation observed in academic centers. No significant financial relationships to disclose.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3