Neoadjuvant and adjuvant chemotherapy in locally advanced bladder cancer

Radical cystectomy has traditionally been considered the gold standard of treatment for patients with muscle-invasive bladder cancer. Following cystectomy a significant portion of patients will develop systemic relapse, usually within 2 to 3 years. Several randomized trials of neoadjuvant and adjuvant chemotherapy suggest that chemotherapy used in combination with primary treatment may improve disease-free survival and permit bladder preservation in selected cases. Whether or not neoadjuvant and adjuvant chemotherapy influence long-term survival remains controversial. This article reviews in depth the various therapeutic options available to patients with locally invasive bladder cancer.