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Use of perioperative chemotherapy in patients treated with radical cystectomy for bladder cancer

No. 115. Use of perioperative chemotherapy in patients treated with radical cystectomy for bladder cancer. Mun Sem Liew 1,2 , Ali Tafreshi 1 , Renu Eapen 3 , Ian D Davis 1,2,4,5 , Shomik Sengupta 2,3,4

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Use of perioperative chemotherapy in patients treated with radical cystectomy for bladder cancer

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  1. No. 115 Use of perioperative chemotherapy in patients treated with radical cystectomy for bladder cancer Mun Sem Liew1,2, Ali Tafreshi1, Renu Eapen3, Ian D Davis1,2,4,5, Shomik Sengupta2,3,4 1Joint Austin-Ludwig Oncology Unit, 2Ludwig Institute for Cancer Research, 3Austin Health; 4University of Melbourne; 5Monash University Posters Proudly Supported by: Results cont’d • Introduction • Neoadjuvantchemotherapy (NAC) improves overall survival 5-6% in muscle-invasive bladder cancer (MIBC)1,2,3 • Less convincing evidence for the use of adjuvant chemotherapy (AC), but most would consider in patients with extra-vesical (≥pT3) or nodal disease4 • Use of perioperative chemotherapy (PC) in Australian practice not well studied Fig 1:Patterns of use of perioperative chemotherapy 2004 to 2011. Uro-oncology multidisciplinary meeting introduced in 2007 . • Aim • Assess utilisation of PC with radical cystectomy (RC) at our institution & determine its impact on oncological outcomes • Methods • Retrospective analysis of all patients’ who underwent RC &/or PC between 2004 and 2011 • Patient co- morbidities quantified by age-adjusted Charlson index (AACI). Stratified into low (≤2), medium (3-5) and high (≥6) groups • Survival analyses using Kaplan – Meier technique • Cox proportional hazard models for multivariate analysis Fig 2: Relationship between RFS and use of peri-operative chemotherapy Fig 3: Relationship between OS and use of peri-operative chemotherapy • Results • 89 patients, of median (range) age 65y (37-84); 66 (74%) males • Pathologic features: pure urothelial (78%) • 28 (31%) patients received PC: • 7 (11%) NAC, 17 (19%) AC, 4 (5%) both • Clear trend over time increased in the use of NAC but not AC (Fig 1) • Univariateanalysis showed T-stage and N-stage, but not age or AACI impacting chemo usage. • Only T-stage remains significant (OR 2.75, CI 1.39-5.45, p<0.005) on multivariate analysis • Similar relapse free and overall survivals regardless of PC (Fig 2 and 3) • But after adjusting for age, pT stage and pNstage: • Better relapse free survival (RR 2.63,p<0.05) • Trend toward better overall survival (RR 2.44, p=0.057) • Conclusions • Increasing use of neoadjuvant chemotherapy over the time period • However, perioperative chemotherapy remains under-utilised • Patients received perioperative chemotherapy had poorer prognostic features • Perioperative chemotherapy improved relapse free survival with a trend toward improved overall survival • References • Grossman et al. NEJM 2003. • International Collaboration of Trialists. JCO 2011. • Collaboration ABCM-a. Cochrane 2010. • Bellmunt et al. Ann Oncology 2010.

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