title: Management of Node-Positive Bladder Cancer After Neoadjuvant Chemotherapy and Radical Cystectomy: A Survey of Current UK Practice.
abstract: BACKGROUND
  Because of the lack of published evidence, this study was done to explore the decisions and rationale of uro-oncology consultants regarding the treatment of patients with muscle-invasive bladder cancer who have positive lymph nodes after radical cystectomy (RC) and neoadjuvant chemotherapy (NAC).
  
  
  METHODS
  An electronic survey was sent to UK pelvic cancer centers regarding: (1) choice of NAC regimen; (2) indications for reimaging; (3) choice and indication of adjuvant chemotherapy (AC) for patients with nodal disease after NAC and RC; (4) choice and indication of chemotherapy regimen if disease continues to progress in patients with advanced bladder cancer; and (5) guidelines used by those surveyed.
  
  
  RESULTS
  Consultant uro-oncologists from 77% of UK pelvic cancer centers responded, who treated a median of 13 patients per year with NAC before RC. Three cycles of gemcitabine and cisplatin was the most common NAC regimen, with 93% and 67% respondents giving it for downstaging of cN1- and cN2- and 3-positive patients, respectively. Forty-five percent would not give AC after NAC and RC in patients with positive lymph nodes. The patient's performance status, followed by response to NAC were key factors in dictating the use of AC. In the presence of disease progression, 46% of participants would use a taxane. Fifty-two percent of responders do not follow any guidelines.
  
  
  CONCLUSIONS
  In the United Kingdom, the treatment of patients with nodal disease after NAC and RC is variable. There is little evidence on which to base the management of such patients. The creation of national and international guidelines might help clinicians to optimize care for these patients.
authors.affiliation: Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Division of Surgery and Interventional Science, University College London, London, United Kingdom. Electronic address: tanweishen@hotmail.com.
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Tan
authors.affiliation: Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Lamb
authors.affiliation: Department of Oncology, University College London Hospitals, London, United Kingdom.
authors.forename: Heather
authors.initials: H
authors.lastname: Payne
authors.affiliation: Department of Oncology, Guy's Hospital, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Hughes
authors.affiliation: Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom; Department of Health and Social Care, London Southbank University, London, United Kingdom.
authors.forename: James S A
authors.initials: JS
authors.lastname: Green
authors.affiliation: Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Lane
authors.affiliation: Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: Adshead
authors.affiliation: Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, United Kingdom.
authors.forename: Greg
authors.initials: G
authors.lastname: Boustead
authors.affiliation: Hertfordshire and South Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, United Kingdom.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Vasdev
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use; D015653:Cystectomy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006306:Health Surveys; D006801:Humans; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy; D016896:Treatment Outcome; D006113:United Kingdom; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine
keywords: Lymph node; Muscle invasive bladder cancer; Transitional cell carcinoma