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Neo-Adjuvant Chemo

11 years 2 months ago #20048 by Patricia
Thanks for the link Newbie...here is what Dr. Herr actually wrote
http://jco.ascopubs.org/cgi/content/abstract/16/4/1298?ijkey=c0d3014d3f2029bf86721dd69f034b96d47a22d3&keytype2=tf_ipsecsha

The study was T2 and Grade 3 for consideration. I was only low grade so could not be part of that study. At the time i saw him in 2002 when he did my re-TURB and got it all no mention of chemo as there was no other involment.
I did notice in the paper you cited that in 38% of patholgical staging it is incorrect...interesting !
I'm looking for some new papers he's written...i'll find them somewhere.
Pat
P.S. i'm still glad i opted for cystectomy at this point.

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11 years 2 months ago - 11 years 2 months ago #20031 by newbie08
Hi Pat,

Glad I can eventually give you an article because your always the one helping me ;)

i found it very interesting too, we are going to email Bochner once my dad finishes chemo about doing another TUR and re grade before scheduling Cystectomy, we know its a long shot and we are prepared for surgery now but if we were in the lucky 54% we would be over the moon, we can always hope eh? :)

I think out of the 54% i.e. 60 people, 48 decided to "wait and see" (presume the others opted for Cystectomy!) and their surivial rate at 10 years was over 74%, that's pretty good odds taking the fact that people of all ages were in the study!!

On the positive side with your RC, at least you know the cancer was REMOVED!!! That gives peace of mind....and I think you wouldn't change you stoma for anything now LOL :P

The link is:
http://annonc.oxfordjournals.org/cgi/content/full/17/9/1360

If you gain any more info from the article let me know, cause I'm new to this i find some parts of the medical articles a bit hard going :blush:

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11 years 2 months ago #20005 by Patricia
Newbie...can you give me the link to that article? Thats very interesting as it is talking about bladder preservation in more advanced stages and grades which has always been...cystectomy..not preservation. Again we are are talking about one of the top hospitals Memorial Sloan in bladder cancer and some surgeons and pathologists with amazing skills. I'd love to know their selection process? And they've got l0 yrs of study on this.
Which begs the question to me...why didn't they offer me into this study? Maybe the enrollment was closed? I was T2 muscle invasive but Dr. Herr the amazing slight of hand surgeon was able to resect my tumor and get it all which was just into the first layer of muscle. At the time of my cystectomy they found no cancer in my bladder..just some stray dysplasic cells floating around. Its just interesting and i'd like to read more.
Thanks ... Pat

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11 years 2 months ago - 11 years 2 months ago #19997 by newbie08
Just wanted to post this article that I read this morning! I think its good to read some positive outcomes, and if I'm honest I'm holding out hope my dad is in the 54%....It cheered up my dad when I read it to him this morning and it certainly gave me a boost!! Even if it only gets us through the chemo....its worth the research!!

Neo-adjuvant chemotherapy also provides an opportunity to consider bladder preservation in select patients who achieve a pathologic complete response. The MSKCC has reported on their experience with neo-adjuvant MVAC followed by bladder-sparing surgery for patients with muscle-invasive T2–T3, N0, M0 bladder cancer [30]. Of 111 patients undergoing neo-adjuvant chemotherapy followed by transurethral resection (TUR), 60 (54%) achieved a complete pathologic response (pT0). Of these 60 patients, 43 underwent bladder-sparing surgery (either TUR or partial cystectomy). After a median follow-up of 10 years, 74% of these patients are alive, with only 30% of patients developing an invasive recurrence. This study suggests that a pT0 afforded by neo-adjuvant chemotherapy may safely permit bladder-preserving surgery in select patients.

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