title: Perioperative chemotherapy for localized bladder cancer.
abstract: BACKGROUND
  Survival benefits have been recently reported in meta-analyses of randomized clinical trials (RCTs) studying perioperative chemotherapy for muscle-invasive urothelial cancer. Controversy and lack of awareness of these data have diminished their impact on daily practice, and they deserve further scrutiny.
  
  
  METHODS
  Recently published meta-analyses of RCTs studying perioperative chemotherapy for bladder cancer were narratively reviewed, along with two reports from the most recently reported RCT of neoadjuvant chemotherapy for bladder cancer.
  
  
  RESULTS
  Two recently published individual patient data meta-analyses report that cisplatin-based combination neoadjuvant chemotherapy is associated with an absolute survival benefit of 5% at 5 years, and adjuvant chemotherapy with an absolute survival benefit of 9% at 3 years. However, the value of the adjuvant meta-analysis is limited by the available data. Positive surgical margins and fewer than 10 lymph nodes removed are associated with poorer prognosis. Pathological complete response is associated with better survival.
  
  
  CONCLUSIONS
  Patients diagnosed with muscle-invasive urothelial cancer may benefit from perioperative chemotherapy and should be routinely referred to a medical oncologist. Surgical factors potentially have a greater impact on survival than the use of perioperative chemotherapy. RCTs studying all stages of localized muscle-invasive bladder cancer are currently enrolling patients in Canada and are a high priority.
authors.affiliation: University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Winquist
mesh_terms: D017024:Chemotherapy, Adjuvant; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*