Evidence versus practice involving universal acceptance of neoadjuvant chemotherapy in muscle-invasive bladder cancer: Results from a tertiary care center in India.

Background: We reviewed the pattern of neoadjuvant chemotherapy (NACT) utilization at our center for patients with muscle-invasive bladder cancer (MIBC) to analyze the reasons behind the delay in cystectomy.

Methods: A retrospective study was planned to review all the cases of carcinoma bladder cT2-T4, N0-3, and M0 with muscle invasion, planned for NACT followed by radical cystectomy (RC) from September 2019 to March 2021. The aim of the study was to identify the barriers and factors that cause a delay in the initiation and continuation of neoadjuvant chemotherapy as well as a delay in radical cystectomy masking the proposed survival advantage of neoadjuvant chemotherapy.

Results: A total of 41 patients with MIBC were planned for NACT. The mean age was 53.75 years (range: 24-68 years). The average time from diagnosis to Transurethral resection of bladder tumor (TURBT), from TURBT to initiation of NACT, for completion of NACT, and from completion to NACT to RC were 17.25, 45.28, 73.15, and 20.12 days, respectively. Out of the 41 patients, 32 (78.1%) received at least the first cycle of NACT, 19 (46.3%) completed NACT, and eight (19.5%) underwent RC. Reasons for delay were attributed to poor compliance, financial reasons, adverse events, subjective feeling of well-being, and COVID-19-associated lockdown.

Conclusion: Several patient-related, treatment-related, and disease-related factors have been identified that result in the underutilization of NAC and unnecessary delay in radical cystectomy. In view of a logistical delay due to these factors, NAC can be avoided in those patients who are expected to have poor compliance, who come from remote areas, or have poor access to health care.