What is the role of chemotherapy in patients with lymph node-positive bladder cancer undergoing radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The treatment of patients with lymph node–positive disease is controversial. Preoperative identification of metastatic lymph nodes typically results in confirmation of disease based on biopsy results followed by chemotherapy. If a meaningful response is seen, subsequent radical cystectomy is an option. When lymph node involvement is identified at the time of surgery, most urologic surgeons proceed with an extended lymphadenectomy and radical cystectomy if all visible disease can be resected. A 2006 retrospective review of 1,121 patients undergoing cystectomy noted that survival increased as the number of lymph nodes removed increased. [29]

However, others advocate halting the surgery, administering chemotherapy, and, if the tumor is chemosensitive, having the patient return for a radical cystectomy and lymph node dissection. No well-designed randomized studies have addressed the role of chemotherapy specifically for patients with node-positive disease following cystectomy. While the role of adjuvant chemotherapy for these patients remains controversial, most experts agree that patients with lymph node involvement should be strongly considered for this therapy.


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