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[Neoadjuvant chemotherapy for invasive bladder cancer]
1Dept. of Urology, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Gan to Kagaku Ryoho. Cancer & Chemotherapy
|December 4, 2001
Summary
Neoadjuvant chemotherapy for muscle invasive bladder cancer aims to eradicate micrometastasis. While not improving survival, chemotherapy response predicts prognosis and enables bladder preservation in select patients.
Area of Science:
- Uro-oncology
- Medical oncology
Context:
- Radical cystectomy is standard for invasive bladder cancer, but distant metastases occur in ~50% of patients post-surgery.
- Neoadjuvant chemotherapy seeks to eliminate micrometastasis and improve outcomes before surgery.
Purpose:
- To evaluate the efficacy of neoadjuvant chemotherapy in muscle invasive bladder cancer.
- To determine if neoadjuvant chemotherapy improves survival and allows for bladder preservation.
Summary:
- M-VAC (methotrexate, vinblastine, adriamycin, cisplatin) therapy has shown promise in advanced cases.
- Randomized trials failed to demonstrate significant survival benefits from neoadjuvant chemotherapy.
- Chemotherapy response is a strong prognostic indicator, enabling bladder preservation in complete responders.
Impact:
- Neoadjuvant chemotherapy can lead to bladder preservation in select patients with complete response.
- It facilitates radical cystectomy in locally advanced, previously unresectable cases.
- May reduce intraoperative tumor cell spread, improving surgical outcomes.