[When should systemic chemotherapy be used for urinary bladder carcinoma?]

The perioperative use of chemotherapy regimens in urinary bladder carcinoma is still under debate. Evidence from clinical trials has not changed over the last decade and therefore current guidelines lack high grade recommendations for the use of perioperative chemotherapy, especially with regard to adjuvant chemotherapy. Neoadjuvant chemotherapy is capable of downsizing locally advanced tumors which leads to better operability. However, the quality of the surgical procedure has a major impact on the risk of recurrence and prognosis of patients and may therefore negatively influence the results of perioperative chemotherapy trials. A number of retrospective studies analyzing the outcome of patients after radical cystectomy have demonstrated that especially patients with node positive bladder carcinoma may benefit from adjuvant chemotherapy. Gemcitabine plus cisplatin still represents the gold standard in the treatment of metastastic bladder carcinoma. Vinflunin has become the standard therapy in second-line treatment and should represent the comparator for further clinical trials in this setting.