Adjuvant cisplatin based chemotherapy after definitive local treatment for T2-4 N0-2 bladder cancer is associated with an absolute overall survival benefit of 9% and disease free survival benefit of 12% at 3 years
This landmark review paper looked at 6 randomised trial data of 491 patients with T2-T4 bladder cancer treated by cystectomy or cystectomy + radiotherapy or primary radiotherapy and comparing the benefit of adjuvant cisplatin based chemotherapy v no chemotherapy. The mean age was 62, most patients had T2-T3 (59% T3) disease and 62% were lymph node negative whereas 34% were node positive. The chemotherapy was 2 to 3 cycles of cisplatin (plus another agent usually) every 3-4 weeks. Overall survival was better with adjuvant chemotherapy with a 25% relative risk reduction of death, equal to a 9% absolute overall survival benefit at 3 years. In terms of disease-free survival there was a 32% relative risk reduction in recurrence risk with chemotherapy, which is an absolute improvement in disease-free survival of 12% at 3 years.