title: Is adjuvant chemotherapy for bladder cancer safer in patients with an ileal conduit than a neobladder?
abstract: OBJECTIVE
  To assess the safety of adjuvant chemotherapy in patients with neobladder reconstruction in comparison to ileal conduit, as radical cystectomy and urinary diversion is an effective curative surgical treatment for muscle-invasive and high-risk superficial bladder cancer, and adjuvant chemotherapy is usually considered for patients with clinical stage > T2 and nodal metastasis.
  
  
  METHODS
  We analysed retrospectively patients who had had a radical cystectomy and urinary diversion between 1992 and 2004. Patients with high-risk disease who had adjuvant chemotherapy were identified and stratified based on the type of urinary diversion (ileal conduit or neobladder). The chemotherapy regimen, complications from the adjuvant chemotherapy and other relevant data were analysed.
  
  
  RESULTS
  Overall, 343 patients had radical cystectomy, 40 had adjuvant chemotherapy; 25 had an ileal conduit and 15 had a neobladder. Patient characteristics including age, stage and follow-up were similar. In all, 55% of patients had grade 1 toxicity, 23% grade 2, 18% grade 3, and 13% grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the toxicity among the two groups.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy appears to be safe in patients with a neobladder and equally safe in patients with an ileal conduit. Hence neobladder reconstruction should not be denied to patients with bladder cancer who are at high risk of recurrence and who might require adjuvant chemotherapy.
authors.affiliation: Department of Urology, University of Miami School of Medicine, Miami, FL 33101, USA.
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.forename: Martha A
authors.initials: MA
authors.lastname: Reyes
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Kava
authors.forename: Rakesh
authors.initials: R
authors.lastname: Singal
authors.forename: Sandy S
authors.initials: SS
authors.lastname: Kim
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014547:Urinary Diversion