TY - JOUR AU - Ajib, Khaled AU - Tjong, Michael C. AU - Tan, Guan Hee AU - Nason, Gregory J. AU - Berjaoui, Mohammad Baker AU - Erlich, Annette AU - Maganti, Manjula AU - Sridhar, Srikala S. AU - Fleshner, Neil E. AU - Zlotta, Alexandre R. AU - Catton, Charles AU - Berlin, Alejandro AU - Chung, Peter AU - Kulkarni, Girish S. PY - 2020/06/16 Y2 - 2024/03/28 TI - Canadian experience of neoadjuvant chemotherapy on bladder recurrences in patients managed with trimodal therapy for muscle-invasive bladder cancer JF - Canadian Urological Association Journal JA - CUAJ VL - 14 IS - 12 SE - Original Research DO - 10.5489/cuaj.6459 UR - https://cuaj.ca/index.php/journal/article/view/6459 SP - 404-10 AB - <p><strong>Introduction:</strong> Bladder preservation with trimodal therapy (TMT) has emerged as a feasible alternative to radical cystectomy in patients with muscle-invasive bladder cancer. Neoadjuvant chemotherapy (NAC) was proven to cause pathological downstaging. For this reason, we evaluated whether receipt of NAC decreases local bladder recurrences in TMT patients.</p><p><strong>Methods:</strong> We retrospectively analyzed our TMT database for all patients treated between 2003 and 2017. Patients were treated with maximal transurethral resection of bladder tumor (TURBT) followed by chemotherapy/radiotherapy with or without NAC. Baseline demographic and tumor characteristics were recorded. Rates of local and systemic recurrence were analyzed per receipt of NAC. Overall recurrence-free survival (RFS) and bladder (b)RFS were analyzed using the Kaplan-Meier method and Cox proportional hazards modelling.</p><p><strong>Results:</strong> Median age and followup periods were 72 years and 3.6 years, respectively. Fifty-four patients had NAC and concurrent chemoradiation (NAC-TMT) vs. 70 patients who had concurrent chemoradiation only (TMT). Carcinoma in situ (CIS) was present in 31% of the patients in NAC-TMT group compared to 24% in TMT group (p=0.40). After treatment, 24 (44%) and 31 (44%) patients in NAC-TMT and TMT groups, respectively, had bladder tumor recurrence. Overall RFS at three years was 46% and 50% in NAC-TMT and TMT groups, respectively (p=0.70). BRFS at three years was 55% and 69% in NAC-TMT and TMT groups, respectively (p=0.27). Multivariable analyses found that the presence of concomitant CIS (hazard ratio [HR] 2.13; 95% confidence interval CI 1.06–4.27; p=0.0036) was the primary factor associated with local bladder recurrence.</p><p><strong>Conclusions:</strong> Receipt of NAC does not obviate the risk of bladder recurrence post-TMT. Patients with CIS should be monitored especially closely for local recurrence.</p> ER -