Maximizing cure for muscle-invasive bladder cancer: integration of surgery and chemotherapy.
BACKGROUND
The optimal treatment strategy for muscle-invasive bladder cancer remains controversial.


OBJECTIVE
To determine optimal combination of chemotherapy and surgery aimed at preserving survival of patients with locally advanced bladder cancer.


METHODS
We performed a critical review of the published abstract and presentation literature on combined modality therapy for muscle-invasive bladder cancer. We emphasized articles of the highest scientific level, combining radical cystectomy and perioperative chemotherapy with curative intent to affect overall and disease-specific survival.


RESULTS
Locally invasive, regional, and occult micrometastases at the time of radical cystectomy lead to both distant and local failure, causing bladder cancer deaths. Neoadjuvant and adjuvant chemotherapy regimens have been evaluated, as well as the quality of cystectomy and pelvic lymph node dissection.


CONCLUSIONS
Prospective, randomized clinical trials argue strongly for neoadjuvant cisplatin-based chemotherapy followed by high-quality cystectomy performed by an experienced surgeon operating in a high-volume center. Adjuvant chemotherapy after surgery is also effective when therapeutic doses can be given in a timely fashion. Both contribute to improved overall survival; however, many patients receive only one or none of these options, and the barriers to receiving optimal, combined, systemic therapy and surgery remain to be defined. An aging, comorbid, and often unfit population increasingly affected by bladder cancer poses significant challenges in management of individual patients.
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Andrew H
AH
Feifer
Jennifer M
JM
Taylor
Tatum V
TV
Tarin
Harry W
HW
Herr
D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D006801:Humans; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*
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