title: Neoadjuvant chemotherapy preceding cystectomy for bladder cancer.
abstract: BACKGROUND
  Occult micrometastasis at the time of radical cystectomy leads predominantly to distant failures in patients with locally advanced, muscle-invasive transitional cell carcinoma of the bladder.
  
  
  OBJECTIVE
  Data supporting neoadjuvant chemotherapy for locally advanced bladder cancer are reviewed.
  
  
  RESULTS
  Studies evaluating adjuvant chemotherapy have been limited by inadequate statistical power. However, randomized clinical trials have demonstrated a survival benefit for neoadjvuant cisplatin-based combination chemotherapy. Trials employing neoadjuvant therapy are particularly valuable in the development of novel systemic therapy regimens, since pathological complete remission appears to be a powerful prognostic factor for long-term survival.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy is a standard for the therapy of locally advanced bladder cancer, and the neoadjuvant paradigm may assist in accelerating novel agent development.
authors.affiliation: Texas Oncology, P.A. and US Oncology Research, 501 Medical Center Blvd, Webster, TX 77598, USA. gurUSonpavde@usoncology.com
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Gilad E
authors.initials: GE
authors.lastname: Amiel
authors.forename: Martha P
authors.initials: MP
authors.lastname: Mims
authors.forename: Teresa G
authors.initials: TG
authors.lastname: Hayes
authors.forename: Seth P
authors.initials: SP
authors.lastname: Lerner
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015653:Cystectomy; D006801:Humans; D019042:Muscle Neoplasms / Q000188:drug therapy / Q000556:secondary; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D016032:Randomized Controlled Trials as Topic; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents