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Integration of neoadjuvant and adjuvant chemotherapy and cystectomy in the treatment of muscle‐invasive bladder cancer
Author(s) -
Milowsky Matthew I.,
Stadler Walter M.,
Bajorin Dean F.
Publication year - 2008
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2008.07980.x
Subject(s) - cystectomy , medicine , bladder cancer , chemotherapy , lymph node , malignancy , perioperative , oncology , dissection (medical) , cancer , neoadjuvant therapy , cisplatin , surgery , breast cancer
Bladder cancer is a potentially curable malignancy but for those patients who present with or develop muscle‐invasive disease, there is a high risk of metastases and cancer‐related death. The treatment of patients with muscle‐invasive bladder cancer uses a multimodal approach, including radical cystectomy with pelvic lymph node dissection and perioperative chemotherapy. Neoadjuvant cisplatin combination chemotherapy has a modest survival benefit, with those patients achieving a complete pathological response after chemotherapy having the best outcome. Adjuvant chemotherapy, although less well substantiated, is a reasonable option for patients with extravesical disease or lymph node involvement after cystectomy. Perioperative chemotherapy is substantially underused despite the level‐1 evidence showing a survival benefit. Ongoing research will focus on individualized patient care, with biomarkers to predict a pathological complete response and the development of novel targeted therapies.