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The past decade has seen important progress in our understanding of the biology and management of bladder cancer, one of the most common malignancies in Western society. Important concepts have emerged regarding the functional heterogeneity of bladder tumours that appear similar under the light microscope, but which are composed of subpopulations of cells with different metastatic and invasive properties (Brown et al., 1990). Extensive data have been produced with regard to newer and more accurate indices of prognosis, including the expression of epidermal growth factor receptor, DNA content, marker chromosomes and the expression of oncogenes, as reviewed in detail elsewhere (Raghavan et al., 1990). However, it has become increasingly clear that, despite the best available treatment, approximately 50 per cent of patients presenting with invasive transitional cell carcinoma will die within 5 years (Skinner & Lieskovsky, 1984; Gospodarowicz et al., 1989). The traditional determinants of adverse prognosis include advanced tumour stage, size, high grade, and the presence of hydronephrosis (Shipley et al., 1984; Gospodarowicz et al., 1989), and studies are in progress to determine the relative utility of these factors, compared to the more recently introduced determinants listed above. Patients with loco-regional recurrence or distant metastases have been treated with systemic cytotoxics, occasionally achieving dramatic remissions. As a result, patients with invasive, but clinically non-metastatic bladder cancer have

Chemotherapy for advanced bladder cancer: 'Midsummer Night's Dream' or 'Much Ado About Nothing'?