When to choose adjuvant chemo vs neoadjuvant therapy.

6 years 4 months ago #53331 by Bikis
Sounds great.

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6 years 6 months ago #52953 by GabeM
Thanks Jack,

I'm already past the RC decision. Only question is staging of chemo and which surgical/oncology team is the best fit. I will have a much clearer idea once the specialists have weighed in

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6 years 6 months ago #52952 by Jack R

Only you and your doctors are familiar with YOUR situation and have the ability to reach reasonable conclusions. All that can be offered here is opinion from people have been dealing with their own somewhat similar medical condition.

That said, may I suggest that helpful questions may be along the line of, "Was the tumor completely removed; were there clear margins around the tumor AND has this tumor created a great risk of immediate metastasis?"

The follow up question would be, "Is it reasonable and safe to delay RC surgery to allow time for preoperative chemotherapy?"

The second question is likely to be the more difficult for the care team to answer. An RC at any stage is not a 100% cure. Physician judgment and recommendation is an important part of the decision making process

I understand your concern and quest. I have been advised that a RC is the "safest" route for me to take. My situation is not yours; when/if I decide to go the RC route, I will assume that there is a chance of undetected metastasis and will do chemo first.

I read extensively, and offer two articles that address the RC decision and long term outcome considerations. I found these helpful



The second article is from a highly respected source, Moffitt.


6/2015 HG Papillary & CIS
3 Years and 30 BCG/BCG+Inf
Tis CIS comes back.
BC clear as of 5/17 !
RCC found in my one & only kidney 10/17
Begin Chemo; Cisplatin and Gemzar
8/18 begin Chemo# 3
Begin year 4 with cis
2/19 Chemo #4
9/19 NED again :)
1/2020 CIS is back
Tried Keytruda, stopped by side effects
Workin on a new plan for 2021

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6 years 6 months ago #52951 by GabeM
Thanks - I realize each case has special considerations - I have not yet met with an oncologist, but have plans to get several opinions beginning next week and intend to come to a decision quickly. I was just wondering if others may have chosen post op chemo for similar reasons as I mentioned - the key being the risk of a breakout during the three month chemo regimen.

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6 years 6 months ago #52950 by Cynthia

Everyone's first reaction is to get it out now. The question you are asking is best discussed with your medical team. Tell them your fears and ask if they are founded. There are studies that show a small survival advantage with doing chemo prior to surgery but what percentage of study perticicpents mirrors your exact situation is always a good question. Again list your questions and go back to your medical team, if you do not have faith in your medical teams advice you should get a second opinion. The reality is that there may not be a decisive answer for your question at this point. From the phrasing of our post I would guess you background is in an area that is fact based such as engineering or the sciences and not a having situation with a solid bottom line is hard to deal with. But in some cases the best you can do is gather what information you can and make a decision based on your gut or trusted advise. Let us know how things are going we will be here for you through this journey.

Cynthia Kinsella
T2 g3 CIS 8/04
Clinical Trial
Chemotherapy & Radiation 10/04-12/04
Chemotherapy 3/05-5/05
BCG 9/05-1-06
RC w/umbilical Indiana pouch 5/06
Left Nephrectomy 1/09
President American Bladder Cancer Society

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6 years 6 months ago - 6 years 6 months ago #52949 by GabeM
I am newly diagnosed with aggressive, muscle invasive non-metastatic bladder cancer (T2b). In my case, I am 69 and otherwise in excellent shape. A 7 cm lesion was resected from the right bladder wall with positive pathology reported 2 days ago. CT did not show penetration of the bladder wall nor enlargement of promixal lymph nodes. The tumor had arisen within the past 10 mos, indicating a very rapid progression.

I am leaning toward adjuvant chemo in order to get the surgery done asap, given the aggressiveness of disease, size of tumor, and proximity to bladder wall (T2b at least). There is less evidence supporting the impact of adjuvant vs neoadjuvant on recurrence and survival, but as the tumor appears contained, this seems the smartest choice rather than waiting 3 mos with the risk of a possible breakout.

I would appreciate any comments or views on this approach or reasons to go with the more common neoadjuvant regime - esp regarding the risk of the disease progressing notwithstanding the chemo, tolerability of post-op chemo, etc.


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