Perioperative chemotherapy in advanced bladder cancer: part I. Neoadjuvant treatment

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.