title: [Chemotherapy in perioperative setting for infiltrative bladder cancer].
abstract: BACKGROUND
  Despite an aggressive initial treatment, only 60% of patients with T2-staged bladder tumours, 50% with T3a and 15% with T3b staged-tumours will be alive at 5 years. The purpose of this review is to clarify the potential role of chemotherapy in localised urothelial tumours, which has not been clearly defined.
  
  
  METHODS
  To address this question, we reviewed published randomized trials of chemotherapy in urothelial tumours of the bladder in both neoadjuvant and adjuvant settings from 1980 and 2010 and corresponding meta-analyses in PubMed.
  
  
  RESULTS
  In the neoadjuvant setting, a meta-analysis of individual data from 3005 patients demonstrated an absolute survival benefit of 5.5% at 5 years. Despite these results, neoadjuvant chemotherapy is very rarely proposed in this indication. Comparative trials performed in the adjuvant setting have been limited by major methodological weaknesses, preventing definitive conclusions. In a meta-analysis based on individual data from 491 patients, a 25% reduction in death risk was observed for an absolute gain of 9% at 3 years.
  
  
  CONCLUSIONS
  In light of these data, chemotherapy should be offered early and proposed as a reasonable option for patients for tumours with extravesical extension or with nodal involvement detected postoperatively, neoadjuvant chemotherapy is the standard of care.
authors.affiliation: Département d'oncologie médicale, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France. houede@bergonie.org
authors.forename: N
authors.initials: N
authors.lastname: Houédé
authors.forename: P
authors.initials: P
authors.lastname: Beuzeboc
authors.forename: S
authors.initials: S
authors.lastname: Culine
authors.forename: M
authors.initials: M
authors.lastname: Soulié
authors.forename: C
authors.initials: C
authors.lastname: Pfister
mesh_terms: D017024:Chemotherapy, Adjuvant; D006801:Humans; D020360:Neoadjuvant Therapy; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery