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Defining optimal therapy for muscle invasive bladder cancer
Harry W Herr1, Zohar Dotan, S Machele Donat
1Department of Urology and Genitourinary Oncology Service, Division of Solid Tumor Oncology, Memorial Sloan-Kettering Cancer Center, Cornell University Weill Medical College, New York, New York 10021, USA. herrh@mskcc.org
The Journal of Urology
|January 16, 2007
Summary
The optimal treatment for muscle invasive bladder cancer involves neoadjuvant chemotherapy before radical cystectomy with pelvic lymph node dissection. This strategy improves survival compared to surgery alone.
Area of Science:
- Uro-oncology
- Surgical oncology
- Medical oncology
Background:
- Muscle invasive bladder cancer (MIBC) requires aggressive treatment strategies.
- Optimizing curative therapy delivery is crucial for patient survival.
Purpose of the Study:
- To define the optimal curative strategy for muscle invasive bladder cancer.
- To determine the best approach for delivering curative therapy for MIBC.
Main Methods:
- Systematic review of published reports from 1985 to 2006.
- Analysis of cohort, phase II, and randomized phase III studies (Level 1-3 evidence).
- Focus on treatments for muscle invasive bladder cancer (T2-T4a stage).
Main Results:
- Cisplatin-based chemotherapy combined with radical cystectomy and pelvic lymph node dissection significantly improves survival.
- High-quality surgery is a critical predictor of survival, even with chemotherapy.
- Neoadjuvant chemotherapy is preferred over adjuvant chemotherapy due to better tolerance and completion rates.
Conclusions:
- Neoadjuvant chemotherapy followed by radical cystectomy and complete pelvic lymph node dissection represents the optimal curative strategy for most MIBC patients.
- This combined approach offers superior survival outcomes for muscle invasive bladder cancer.
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