title: The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians.
abstract: Guidelines recommend neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in patients with urothelial carcinoma of the bladder in clinical stages T2-T4a, cN0M0. We examined the frequency and current practice of NAC and sought to identify predictors for the use of NAC in a prospective contemporary cohort.
  
  
  
  We analyzed prospective data from 679 patients in the PROMETRICS (PROspective MulticEnTer RadIcal Cystectomy Series 2011) database. All patients underwent RC in 2011. Uni- and multivariable regression analyses identified predictors of NAC application. Furthermore, a questionnaire was used to evaluate the practice patterns of NAC at the PROMETRICS centers.
  
  
  
  A total of 235 patients (35%) were included in the analysis. Only 15 patients (2.2%) received NAC before RC. Younger age (< 70 years; P = .035), lower case volume of the center (< 30 RC/year; P < .001), and advanced tumor stage (≥ cT3; P = .038) were identified as predictors for NAC. Of the 200 urologists who replied to the questionnaire, 69% (n = 125) declared tumor stage cT3-4 a/o N1M0 to be the best indication for NAC application, although 45% of the urologists stated that they would not perform NAC despite recommendations. The decision for NAC was made by the individual urologist in 69% of cases, and only 29% reported that all cases were discussed in an interdisciplinary tumor board.
  
  
  
  NAC was rarely applied in the present cohort. We observed a discrepancy between guideline recommendations and practice patterns, despite medical indication and pre-therapeutic interdisciplinary discussion. The potential benefit of NAC within a multimodal approach seems to be neglected by many urologists.
authors.affiliation: Department of Urology, University of Ulm, Ulm, Germany. Electronic address: thomas.martini@uniklinik-ulm.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.affiliation: Department of Urology, Urologische Klinik, Klinikum St. Elisabeth Straubing, Straubing, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gilfrich
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, General Hospital of Bolzano, Bolzano, Italy.
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Department of Urology, Klinik Und Poliklinik Für Urologie Und Kinderurologie, Bonn, Germany.
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
authors.affiliation: Department of Urology, Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Wagenlehner
authors.affiliation: Department of Urology, Vivantes Medical Centre Im Friedrichshain and Am Urban, Berlin, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.affiliation: Department of Urology, University Hospital Rostock, Rostock, Germany.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Nuhn
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novotny
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hadaschik
authors.affiliation: Department of Urology, University Hospital of Jena, Jena, Germany.
authors.forename: Marc-Oliver
authors.initials: MO
authors.lastname: Grimm
authors.affiliation: Department of Urology, Hospital Saint John of God Vienna, Vienna, Austria.
authors.forename: Paul
authors.initials: P
authors.lastname: Schramek
authors.affiliation: Department of Urology, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.affiliation: Department of Urology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Daniela
authors.initials: D
authors.lastname: Colleselli
authors.affiliation: Department of Urology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Birgit
authors.initials: B
authors.lastname: Kloss
authors.affiliation: Department of Urology, University of Münster, Münster, Germany.
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Department of Urology, Urologische Klinik, Klinikum St. Elisabeth Straubing, Straubing, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.affiliation: Department of Urology, University of Ulm, Ulm, Germany. Electronic address: christian.bolenz@uniklinik-ulm.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
mesh_terms: D000367:Age Factors; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
keywords: Guideline recommendation; Muscle-invasive bladder cancer; Questionnaire; Radical cystectomy; Tumor board