Grossman - Figure 17
Neoadjuvant Chemotherapy Causes Excess Operative and Postoperative Toxicity
FIG. 17: In addition to the argument that neoadjuvant chemotherapy in bladder cancer does not provide enough benefit, there has been some reluctance to utilize this potential life-saving therapy because (it is argued) it causes excess peri- and postoperative toxicity.
It is evident that when therapies are combined, there is likely to be an increase in toxicity, and in patients with low-volume disease, cystectomy alone may be appropriate. However, as seen in the ABC meta-analysis,[5] Level I evidence has found that cystectomy plus neoadjuvant chemotherapy improves survival in patients with muscle-invasive bladder cancer.
References
Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol. 2005;48:202−5 http://dx.doi.org/10.1016/j.eururo.2005.04.006
