When to choose adjuvant chemo vs neoadjuvant therapy.

Sounds great.

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

Gabe,

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

www.texasoncology.com/types-of-cancer/bladder-cancer/stage-ii-bladder-cancer

moffitt.org/File%20Library/Main%20Nav/Research%20and%20Clinical%20Trials/Cancer%20Control%20Journal/v7n4/article3.pdf

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

Best,
Jack

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.

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.

Thanks.