A 55-year-old man with muscle-invasive bladder cancer (T2N0M0, urothelial carcinoma) is planned for radical cystectomy. Preoperative renal function shows GFR 52 mL/min. According to ASCO/NCCN guidelines, which statement best reflects current evidence-based perioperative management?
- A Adjuvant cisplatin-based chemotherapy after cystectomy is preferred over neoadjuvant chemotherapy for MIBC
- B GFR < 60 mL/min is an absolute contraindication to cisplatin; only carboplatin-based regimens should be given
- C Neoadjuvant cisplatin-based chemotherapy (gemcitabine + cisplatin) should be offered prior to cystectomy given the proven overall survival benefit (5-8% absolute) ✓
- D Radical cystectomy alone without perioperative chemotherapy is the standard due to lack of OS benefit in MIBC
Explanation
Multiple randomised controlled trials (SWOG 8710, BA06 30894) and meta-analyses confirm a 5-8% absolute overall survival benefit with neoadjuvant cisplatin-based chemotherapy (gemcitabine + cisplatin, 4 cycles) prior to radical cystectomy for MIBC. This is the standard-of-care per ASCO, EAU, and NCCN. GFR ≥ 50-60 mL/min (with creatinine < 1.5 x normal) is considered adequate for cisplatin eligibility; this patient's GFR of 52 mL/min is borderline — actual cisplatin eligibility criteria vary slightly but GFR > 50 is generally considered acceptable per current protocols. Adjuvant chemotherapy (nivolumab per IMvigor010 or cisplatin-based) has a more limited evidence base than neoadjuvant in this setting.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.