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Neoadjuvant treatment options for muscle-invasive urothelial bladder cancer

Derek Raghavan, MD, PhD, FACP, FASCO
Section Editors
Philip W Kantoff, MD
Seth P Lerner, MD
Deputy Editor
Michael E Ross, MD


Worldwide, bladder cancer accounts for approximately 450,000 new cases and 165,000 deaths [1]. 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 [7].

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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Literature review current through: Nov 2017. | This topic last updated: Nov 16, 2016.
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