title: Controversies in the treatment of invasive urothelial carcinoma: a case report and review of the literature.
abstract: BACKGROUND
  More than 429,000 patients worldwide are diagnosed with bladder cancer each year and muscle-invasive bladder cancer has an especially poor outcome. The median age at diagnosis is over 70 years, and many patients also have a substantial number of age-associated impairments that need to be considered when planning therapeutic interventions.
  
  
  METHODS
  Here, we report the case of a 63-year-old man with a cT3b urothelial carcinoma which was surgically removed. No neoadjuvant or adjuvant chemotherapy was administered. After 18 months a lung metastasis was confirmed and resected but no chemotherapy was given after surgery. Twelve months later, the patient relapsed and was treated with a combination of gemcitabine and cisplatin and after a decline in renal function the treatment was changed to a combination of carboplatin and gemcitabine which resulted in a partial response which lasted 8 months. Following this vinflunine was administered as a second line treatment. Here we review the evidence available in the literature regarding the suitability of different treatment options for managing muscle-invasive bladder cancer at each step of the case presentation.
  
  
  CONCLUSIONS
  Bladder cancer treatment requires a multidisciplinary approach. Although, depending on the clinical characteristics of the patient, there are some controversial points in the management of this pathology we hope that the scientific data and the clinical trials reviewed in this case report, can help to guide physicians to make more rational decisions regarding the management of these patients.
authors.affiliation: Instituto Valenciano de Oncología, Valencia, Spain. vguillem@fivo.org.|Medical Oncology Department, Instituto Valenciano de Oncologia, C/Prof. Beltrán Báguena, 8-11 46009, Valencia, Spain. vguillem@fivo.org.
authors.forename: Vicente
authors.initials: V
authors.lastname: Guillem
authors.affiliation: Instituto Valenciano de Oncología, Valencia, Spain. macliment@fivo.org.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Climent
authors.affiliation: Hospital Universitario de Guadalajara, Guadalajara, Spain. jacaes@sescam.jccm.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Cassinello
authors.affiliation: Hospital Universitario Central de Asturias, Asturias, Spain. eesteban@seom.org.
authors.forename: Emilio
authors.initials: E
authors.lastname: Esteban
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain. cdanicas@hotmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Castellano
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain. jlgonzalezlarriba@telefonica.net.
authors.forename: José Luis
authors.initials: JL
authors.lastname: González-Larriba
authors.affiliation: Hospital Sant Pau, Barcelona, Spain. jmaroto@santpau.cat.
authors.forename: Pablo
authors.initials: P
authors.lastname: Maroto
authors.affiliation: Consorcio Hospital General Universitario de Valencia and Universitat de Valencia, Valencia, Spain. camps_car@gva.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Camps
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001707:Biopsy, Needle; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy*; D009367:Neoplasm Staging; D011859:Radiography; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome