title: [Impact of neoadjuvant chemotherapy on therapeutic management of muscle-invasive bladder cancer].
abstract: OBJECTIVE
  Assess the toxicity of neoadjuvant chemotherapy (NAC), its impact on surgical schedule and postoperative morbidity of cystectomy for muscle-invasive bladder cancer (MIBC).
  
  
  METHODS
  Retrospective multicentric study of 78 patients who underwent a cystectomy from January 2009 to March 2012 for MIBC. The following criteria have been studied: toxicity of NC (WHO classification), precystectomy interval, postoperative morbidity (Clavien), duration of stay, downsizing on CT-scan before cystectomy, and free of cancer pathology (pT0).
  
  
  RESULTS
  Seventy-eight patients had been included, thirty-nine had a NAC. Thirty-three percent had a incomplete chemotherapy because of toxicity. Forty-eight percent had a significant toxicity and grade ≥ 3 toxicity was 33%. Median time between diagnosis and cystectomy was 12.6 weeks (0.7-38), 18 weeks with NAC (group 1) versus eight weeks without NAC (group 2) (P=0.01). In case of toxicity, the delay was 3.5 weeks longer (P=0.12). After cystectomy, 60% of patients had at least one postoperative complication; including 23% had major morbidity. NAC did not increase neither postoperative morbidity (P=0.15) nor duration of stay (18 vs 20 days; P=0.2). Radiological response rate to NC was 38%. pT0 rate was 79 vs 7.7%. The increase of precystectomy interval after NC did not worsen the pathological stage (P=0.5).
  
  
  CONCLUSIONS
  NC had a high toxicity, but without impact on postoperative morbidity, and precystectomy interval did not have any impact on the prognosis.
  
  
  METHODS
  5.
authors.affiliation: Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France. Electronic address: vincent-meyer@hotmail.fr.
authors.forename: V
authors.initials: V
authors.lastname: Meyer
authors.affiliation: Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon cedex 08, France.
authors.forename: A
authors.initials: A
authors.lastname: Flechon
authors.affiliation: Service de chirurgie urologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Tartas
authors.affiliation: Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: H
authors.initials: H
authors.lastname: Fassi-Fehri
authors.affiliation: Service de chirurgie urologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Ruffion
authors.affiliation: Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: X
authors.initials: X
authors.lastname: Martin
authors.affiliation: Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Colombel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
keywords: Bladder cancer; Cancer de vessie; Chemotherapy; Chimiothérapie néoadjuvante; Cystectomie; Cystectomy; Morbidity; Morbidité; Neoadjuvant therapy; Toxicity; Toxicité; Urothelial tumor