Neoadjuvant treatment options for muscle-invasive urothelial bladder cancer
- Derek Raghavan, MD, PhD, FACP, FASCO
Derek Raghavan, MD, PhD, FACP, FASCO
- Section Editor — Bladder Cancer
- President, Levine Cancer Institute
- Carolinas HealthCare System
- Charlotte, NC
- Section Editors
- Philip W Kantoff, MD
Philip W Kantoff, MD
- Section Editor — Testicular Cancer
- Chairman of Medicine
- Memorial Sloan Kettering Cancer Center
- Seth P Lerner, MD
Seth P Lerner, MD
- Section Editor — Bladder Cancer
- Beth and Dave Swalm Chair in Urologic Oncology
- Professor of Urology
- Baylor College of Medicine
Worldwide, bladder cancer accounts for approximately 450,000 new cases and 165,000 deaths . In developed areas of the world, such as North America and Western Europe, these bladder cancers are predominantly urothelial.
Despite radical cystectomy, approximately one-half of patients with muscle-invasive urothelial (transitional cell) bladder cancer involving the muscularis propria (T2), perivesical tissue (T3), or pelvic structures (T4) develop metastatic disease within two years (table 1); most of these patients will succumb to their disease [2,3]. (See "Epidemiology and risk factors of urothelial (transitional cell) carcinoma of the bladder", section on 'Epidemiology'.)
The preferred management of patients with muscle-invasive bladder cancer consists of a multimodal approach comprising neoadjuvant chemotherapy followed by radical cystectomy. Despite the evidence that neoadjuvant cisplatin-based chemotherapy improves survival compared with locoregional treatment alone, less than 20 percent of patients undergoing radical cystectomy actually receive neoadjuvant chemotherapy [4-6], although this may be increasing at higher-volume centers .
In appropriately selected patients who are not candidates for radical cystectomy or who prefer to retain their native bladder, a combined-modality approach of maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiotherapy is an alternative.
This topic discusses neoadjuvant chemotherapy followed by radical cystectomy for muscle-invasive urothelial bladder cancer. Related topics include:
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- OVERVIEW OF TREATMENT APPROACH
- NEOADJUVANT CHEMOTHERAPY
- Choice of chemotherapy regimens
- - Classic MVAC
- - Dose-dense MVAC
- Patients with renal insufficiency
- Thromboembolic complications
- NEOADJUVANT RADIATION THERAPY?
- ADJUVANT CHEMOTHERAPY
- RADICAL CYSTECTOMY
- POSTTREATMENT SURVEILLANCE AND TREATMENT
- FUTURE DIRECTIONS
- p53 status for risk-directed clinical trials
- Gene expression profiling
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS