title: Muscle invasive bladder cancer: closing the gap between practice and evidence.
abstract: Bladder cancer is the fourth most common cancer in the United States, and will lead to an estimated 15,580 deaths in 2014. Prompted by physical symptoms and signs, most patients will initially present with clinically localized disease. Once bladder cancer invades beyond the muscularis propria, the likelihood of development of metastatic disease increases substantially. Radical cystectomy is potentially curative for muscle-invasive bladder cancer though approximately 50% of patients will develop metastatic recurrence. Two large randomized studies have demonstrated that the use of neoadjuvant cisplatin-based chemotherapy prior to cystectomy improves survival. However, despite the existing level 1 evidence, this approach has been largely underutilized in practice. In this review, we will focus on this disconnect between efficacy and effectiveness and explore possible solutions in an effort to bridge this existing gap.
authors.affiliation: Division of Hematology and Medical Oncology The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai New York, NY, USA - matthew.galsky@mssm.edu.
authors.forename: C K
authors.initials: CK
authors.lastname: Tsao
authors.forename: B C
authors.initials: BC
authors.lastname: Liaw
authors.forename: W K
authors.initials: WK
authors.lastname: Oh
authors.forename: M D
authors.initials: MD
authors.lastname: Galsky
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D015653:Cystectomy / Q000379:methods / Q000401:mortality; D019317:Evidence-Based Medicine; D006801:Humans; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000628:therapy