Perioperative chemotherapy for muscle-invasive bladder cancer

Considerable debate exists concerning the combined use of systemicchemotherapy and radical surgery for muscle-invasive bladdercancer. While there is evidence for a survival benefit afterneoadjuvant chemotherapy, the benefit is modest and the potentialtoxicity and delay of time to surgery prior to cystectomy appearsto be deterring many surgeons from its administration. The evidencefor adjuvant chemotherapy, on the other hand, is less compellingand substantial. Furthermore, the role of adjuvant comparedto salvage chemotherapy requires further investigation.Similarly, research continues on identifying molecular and clinicalmarkers to best stratify patients for optimal perioperative therapy.In this article, the evidence for radical cystectomy andchemotherapy, given either in a neoadjuvant or adjuvant setting,will be reviewed.