Perioperative Chemotherapy in Advanced Bladder Cancer: Part I Neoadjuvant Treatment

Abstract

Despite local tumor control, patients with locally advanced bladder cancer or lymphogenic metastasized urothelial carcinoma are at risk for systemic progress. Radical cystectomy is the gold standard treatment for muscle-invasive bladder tumors. Pelvic lymphadenectomy remains an integral part of the surgical treatment. However, the extent of the lymph node dissection depends on its diagnostic or curative intent and is more controversial. In addition, further treatment options such as systemic chemotherapy or combined radio-chemotherapy are needed to improve the outcome of locally advanced or metastasized disease. Therefore, administration of additional therapy to surgical treatment is intensively studied. The application of the neoadjuvant concept as well as the definite role of the adjuvant chemotherapy currently are contentious topics and subjects of meta-analyses and prospective randomized trials. In addition, bladder preservation as part of a multimodality treatment is still discussed as an option for selected patients unsuitable for radical cystectomy. This article gives an overview on the current concepts of the use of neoadjuvant systemic chemotherapy in the treatment of advanced urothelial cancer.

Trends in the Use of Chemotherapy before and after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer in Korea

“…In 2003, the Southwest Oncology Group (SWOG)-8710 randomized controlled trial demonstrated improved survival and pathologic down-staging in association with the use of neoadjuvant chemotherapy (NAC) administered before RC in patients with MIBC ( 7 ), and the results from subsequent meta-analyses have also suggested significant benefits associated with NAC ( 8 9 ). However, the adoption of NAC for MIBC has been slow and inconsistent among oncologists, and only 1%-12% of MIBC patients receive NAC ( 6 7 10 11 12 13 ). Several explanations have been proposed for the slow uptake of the use of NAC for MIBC, including the significant toxicities of the chemotherapeutic agents, the higher proportions of older MIBC patients with multiple comorbidities, poor renal function, and poor performance statuses.…”