[Inductive chemotherapy of bladder cancer. A critical evaluation]

Cisplatin-based inductive chemotherapy can induce remissions of locally invasive bladder cancer; these can be observed after two cycles of chemotherapy. Non-transitional cell carcinomas of the bladder do not respond to this therapy. The toxicity of inductive chemotherapy is acceptable. The clinical staging after inductive or neo-adjuvant chemotherapy does not correlate with the pathological staging after cystectomy. This discrepancy indicates that bladder preservation after inductive chemotherapy will not be possible until the diagnostic methods are improved enough to correlate exactly with the pathological findings. Many questions remain open with respect to this form of treatment of locally advanced bladder cancer. This is why patients should only be treated with inductive or neo-adjuvant chemotherapy within the context of controlled prospective clinical trials. On the basis of our current knowledge inductive chemotherapy cannot be considered as a definitive form of treatment for locally invasive bladder tumours.