Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
The optimal treatment strategy for muscle-invasive bladder cancer remains controversial.
To determine optimal combination of chemotherapy and surgery aimed at preserving survival of patients with locally advanced bladder cancer.
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.
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.
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.
Written by:
Feifer AH, Taylor JM, Tarin TV, Herr HW.
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Reference: Eur Urol. 2011 Jan 18. Epub ahead of print.
doi: 10.1016/j.eururo.2011.01.014
PubMed Abstract
PMID: 21257257
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