[Neoadjuvant chemotherapy for invasive bladder cancer]

Although radical cystectomy is the gold standard for invasive bladder cancer, about half of the patients develop distant metastases within two years after operation. Objectives of preoperative (neoadjuvant) chemotherapy in muscle invasive bladder cancer are eradication of micrometastasis and subsequent improvement of prognosis. Based on favorable outcome of M-VAC (methotrexate, vinblastine, adriamycin, cisplatin) therapy in advanced cases, several clinical trials have been performed. Unfortunately, results of the randomized prospective studies failed to demonstrate survival benefits. However, response to the preoperative chemotherapy has been found to be an excellent prognostic factor, and preservation of the bladder (complete preservation or partial cystectomy) is possible in selected cases with complete response. Moreover, good local control by neoadjuvant chemotherapy enables cystectomy in selected cases of locally-advanced cancer once considered unresectable, and may lead to suppression of intraoperative spread of the tumor cells.