Risk Adaptive Neoadjuvant Chemotherapy in Muscle Invasive Bladder Cancer

Muscle invasive bladder cancer (MIBC) is an aggressive tumor with a high rate of early systemic dissemination. The main treatment for MIBC is still radical cystectomy and lymph node dissection. Survival rates for 5-year are 70-80% for organ-confined disease and 20-30% for extravesical disease. Although surgery provides excellent control for organ-confined bladder cancer, recurrences are common in surgery alone. Therefore, it is important to treat micrometastatic disease with perioperative chemotherapy. Although there are grade 1 evidences for use of cisplatin-based neoadjuvant chemotherapy (NAC), utilization of NAC rates are still very low all over the world. Thus, approaches trying to determine the selection of appropriate patients for NAC were investigated. High-risk groups to benefit from NAC includes palpable mass in the detection under anesthesia before surgery, clinical T3 or T4a disease, hydronephrosis, lymphovascular invasion and aggressive variant histology. Risk adaptive approaches based on clinicopathologic parameters may increase the rate of benefit from NAC until routine usage of molecular markers and methods that can detect micrometastatic disease