A 65-year-old patient with muscle-invasive bladder cancer (T2bN0M0, transitional cell carcinoma) is fit for surgery. The SWOG 8710 trial established which management paradigm for muscle-invasive bladder cancer?
- A Adjuvant chemotherapy after radical cystectomy is the preferred sequence
- B Neoadjuvant chemotherapy (MVAC or GC) followed by radical cystectomy improves overall survival compared to cystectomy alone ✓
- C Chemoradiotherapy (trimodal therapy) is equivalent to radical cystectomy for T2 disease
- D TURBT followed by immunotherapy with BCG instillation is the standard for T2 disease
Correct answer: B. Neoadjuvant chemotherapy (MVAC or GC) followed by radical cystectomy improves overall survival compared to cystectomy alone
Explanation
The SWOG 8710 (INT-0080) trial demonstrated that neoadjuvant MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) chemotherapy followed by radical cystectomy significantly improved 5-year overall survival compared to cystectomy alone (57% vs 43%, p=0.06) in muscle-invasive bladder cancer, with a significant improvement in median survival. This established the neoadjuvant chemotherapy paradigm for MIBC. Adjuvant chemotherapy lacks Level 1 evidence for OS benefit. BCG is for non-muscle-invasive disease only.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.