1436 SYSTEMIC CHEMOTHERAPY HAS BEEN INCREASINGLY ADOPTED FOR UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive (I)1 Apr 20131436 SYSTEMIC CHEMOTHERAPY HAS BEEN INCREASINGLY ADOPTED FOR UROTHELIAL CARCINOMA Matthew Maurice and Hui Zhu Matthew MauriceMatthew Maurice Cleveland, OH More articles by this author and Hui ZhuHui Zhu Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2790AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Over the last decade, growing evidence supports the use of systemic chemotherapy (SC) for muscle-invasive urothelial carcinoma (UC) with neoadjuvant SC offering a definitive survival benefit. We examined the trend of SC use in the United States (US). METHODS The National Cancer Database (NCDB) captures about 70% of all newly diagnosed cancer cases in the US. We queried the NCDB from 2000-2010 for UC treated with SC. Specifically, we examined its usage overall, by stage, and with various local therapies: external beam radiation (RT), any UC surgery (SX), and cystectomy (CX) (i.e. partial or complete/radical cystectomy or exenteration). RESULTS From 2000-2010, overall SC usage steadily increased (7.9% to 20.2%), while CX and RT use remained constant (Figure 1). A similar trend was seen with the use of SC-SX combination therapy, which increased for all UC stages (most rapidly for stages 2 and 3) without significant change in the stage of incident UC (Figure 2). In contrast, the use of SC alone (without SX) increased only for stage 2 UC (7.7% to 12.5%), and this trend was mirrored by an increase in RT (14.5% to 17.7%) and a decrease in CX (34.2% to 28.6%) (Figure 3). For stage 2 UC, patients receiving SC or RT were 1.5-1.7x more likely to be ≥70 years old and have ≥2 comorbidities than those undergoing CX. CONCLUSIONS Last decade, adjuvant/neoadjuvant SC was rapidly adopted for the treatment of UC in the US, especially for stages 2 and 3 UC. In addition, SC was increasingly used in conjunction with RT for stage 2 UC, likely representing the adoption of primary chemoradiation therapy. Unexpectedly, SC use appears to be increasing for stages 0 and 1 UC while the stage of incident UC remains stable, calling into question whether this practice represents UC overtreatment or chemo-induced downstaging. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e588 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Maurice Cleveland, OH More articles by this author Hui Zhu Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...