title: Neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer: The likelihood of initiation and completion.
abstract: BACKGROUND
  Chemotherapy was shown to improve survival in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). The initiation and completion rates for perioperative chemotherapy are variable. Our aim is to compare the likelihood of initiating and completing neoadjuvant (NAC) and adjuvant chemotherapy (AC) in patients who underwent of RC for MIBC.
  
  
  METHODS
  We performed a retrospective analysis of patients who underwent RC between 1992 and 2011. NAC was advised for patients with clinical stage ≥T2, hydronephrosis, extensive lymphovascular invasion (LVI), or prostatic stromal invasion. Patients with ≥pT3 or lymph node metastases were considered for AC.
  
  
  RESULTS
  A total of 363 patients were considered for perioperative chemotherapy. Among the 141 patients who were offered NAC, 125 (88.6%) initiated NAC. A total of 222 were considered for AC, and 151 (68.0%) initiated AC (P < 0.001). In the NAC group, 118 (83.5%) completed planned number of cycles of chemotherapy and 7 (5.6%) did not complete the planned chemotherapy. In the AC group, 79 (35.5%) completed at least four cycles and 72 (47.3%) could not complete the planned cycles (P < 0.001).
  
  
  CONCLUSIONS
  Patients with MIBC are more likely to initiate and complete NAC than AC.
authors: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors: Ahmed
authors: A
authors: Eldefrawy
authors: Mark S
authors: MS
authors: Soloway
authors: Devendar
authors: D
authors: Katkoori
authors: Rakesh
authors: R
authors: Singal
authors: David
authors: D
authors: Pan
authors: Murugesan
authors: M
authors: Manoharan
keywords: Adjuvant; bladder cancer; chemotherapy; completion; neoadjuvant; radical cystectomy