Some Surgeons Set in Their Ways

Bladder cancer treatment with chemotherapy before surgery underutilized

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Medicine can be a conservative field, and even when there is clear evidence in support of doing things differently, it may take some time for those changes to filter into practice.

Starting in 2003, new guidelines for bladder cancer therapy were developing to include chemotherapy before surgery to treat advanced bladder cancer.  

"Ask your surgeon about chemotherapy before surgery."

A presentation at the annual meeting of the American Society of Clinical Oncology looked at surgical records from the Veteran's Affairs Medical Center in St. Louis, Missouri. The research team looked at how closely the new guidelines were followed from 1997 to 2007, covering the time period when the recommended treatment change was made.

The researchers found that despite the clear benefit documented, nearly a decade ago, only six percent of all the patients in the study had been given chemotherapy before surgery.

Researchers found that the percentage of surgeons using chemotherapy beforehand had increased over the last decade, but change from the stand-alone surgical treatment was slow in coming.

Year by year, chemotherapy before surgery was given three percent of the time, before the guidelines were changed in 2003.

When the study ended a decade later in 2007, the percentage had increased to 14 percent.

The evidence behind recommending chemotherapy before surgery, a treatment called neoadjuvant chemotherapy, was the conclusion of researchers who completed an 11 year study following 307 patients back in 2003.

The study in 2003, by the University of Texas MD Anderson Cancer Center, found that patients treated with chemotherapy prior to surgery lived nearly three years longer on average, and were less likely to die of bladder cancer than patients treated with surgery alone.

Those results were impressive enough to prompt a change in policy for advanced bladder cancers that had started to grow into muscle, as the study's principal investigator, H. Barton Grossman, MD and professor of urology at the University of Texas documented.

"There were significantly more patients in the neoadjuvant group who had no residual disease compared to the surgery group and those are the patients that have much better survival. The chemotherapy effectively down-staged their cancer," stated Dr. Grossman.

"Ten years after treatment, some of those patients are still alive, so neoadjuvant chemotherapy before surgery provided a cure for them."

Study findings presented at conferences should be considered preliminary until published in a peer-reviewed journal.

No financial conflicts of interest were disclosed by researchers.

Reviewed by: 
Review Date: 
June 23, 2012
Last Updated:
June 27, 2012