title: Multimodal therapies for muscle-invasive urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  To evaluate the current literature for processes of care and outcomes of multimodal therapies for muscle-invasive urothelial carcinoma of the bladder.
  
  
  RESULTS
  Treatments for high-risk bladder cancer remain an active area of investigation. Despite evidence of the benefits, the use of chemotherapy, either neoadjuvant or adjuvant, remains underutilized. Given patient preference or baseline comorbidities, multimodal bladder-preserving strategies have been employed by several institutions, with rates of overall survival similar to radical cystectomy series. Late complications associated with these treatments were recently described. Future management strategies for solid tumors will incorporate a personalized approach based upon molecular diagnostic tools to predict risk of recurrence, progression, and response to specific therapeutic agents.
  
  
  CONCLUSIONS
  Multimodal paradigms for muscle-invasive urothelial carcinoma have demonstrated favorable clinical outcomes relative to radical cystectomy alone. Further work through properly conducted randomized trials and accurate individual-level risk assessments will facilitate the determination of the optimal candidates and timing for these treatments.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Keegan
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Resnick
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents