Neoadjuvant treatment in muscle-invasive bladder cancer how multidisciplinary team meetings improve patients’ outcome: a single institution experience

Keywords

multidisciplinary team - meetings - muscle-invasive bladder cancer - neoadjuvant - outcome

Introduction: The treatment of muscle-invasive bladder cancer (MIBC) is complex and requires a multidisciplinary collaboration among surgery, radiation, and medical oncology. Although neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) and lymph node dissection has been considered the standard treatment for MIBC. Determining the optimal treatment for each individual patient with MIBC requires efficient collaboration between healthcare providers. Today, multidisciplinary team meetings (MDTMs) help in decision-making and treatment decisions about providing personalized therapeutic plans for patients.

Methods: A retrospective, single-center cohort study in which patients undergoing radical cystectomy were selected and were subdivided into two groups according to whether or not neoadjuvant therapy was performed. Participants were allocated to two groups according to the implementation of the multidisciplinary team meetings in 2021, 2019 before the meetings and 2022 after. The effects of the discussions between the groups were compared. The results were obtained through statistical analysis (SPSS version 22.0) of several characteristics, such as: time to oncology consultation, time to neoadjuvant therapy, time to cystectomy, time to adjuvant. A secondary objective was to quantify the effect of neoadjuvant on the stage of the tumor.

Results: Forty patients were selected, nineteen from 2019 and twenty-one after the start of the meetings. Approximately 85% of patients were discussed at the multidisciplinary team meetings. There was an increase in the neoadjuvant therapy rate from 25% to 37,5%. There was a change in the profile of neoadjuvant medications, with more MVAC used in 2022 (0% vs 80%, p = 0.071), with no serious complications recorded. The adjuvant therapy rate was higher (26.7% vs 35.7%) and there was a reduction in the median number of weeks for oncology consultation since diagnosis (28 vs 5, p = 0.062). Although there was no statistical significance in the times to neoadjuvant therapy and time to cystectomy, there was a trend towards their reduction (7.6 vs 6.2 and 13.3 vs 8.4 weeks, respectively).

Conclusion: Multidisciplinary meetings can positively impact different oncological outcomes, as seen in international series. The results of the present study demonstrated a trend of benefit to treatment after the establishment of the meetings, although the short selection period and number of patients included negatively interfered in this analysis.

Corresponding author: Najla Pinheiro Navarros (e-mail: [e-mail]).

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
06 May 2025