Treatment of muscle-invasive bladder cancer: progress and new challenges.
The management of muscle-invasive bladder cancer has evolved over the last 20 years. Radical surgery, while curative for a significant number of patients, is inadequate for a subgroup with aggressive features including, but not limited to, advanced local stage, lymphovascular invasion on transurethral resection specimen, or variant histology such as small cell carcinoma. It is now clear that chemotherapy can improve the outcome for such patients. Combination platinum-based neoadjuvant chemotherapy is associated with a survival advantage of 5-8% at 5 years over local therapy alone. Improvements in surgical technique are also important and need to be further refined. Biologic-based staging and targeted therapies hold promise for the future. The critical issue in multimodal therapy for this very heterogeneous disease is individualized patient selection. In this review, data are presented with emphasis on the practical application of current knowledge to the management of patients with muscle-invasive bladder cancer.
Herring
Judi C
JC
Division of Urology, Department of Surgery, University of Florida, 555 West Eighth Street, Pavilion, 2 South, Jacksonville, FL 32209, USA. judi.herring@jax.ufl.edu
Kamat
Ashish M
AM
D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D017048:Health Care Costs; D006801:Humans; D008197:Lymph Node Excision; D018482:Muscle, Skeletal / Q000473:pathology; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011788:Quality of Life; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery
D000970:Antineoplastic Agents; D002945:Cisplatin