Neoadjuvant Chemotherapy: A New Standard for Muscle Invasive Bladder Cancer?

Bladder cancer is the seventh most common cancer and the ninth most common cause of cancer deaths for men worldwide. Cystectomy with pelvic lymph nodes dissection is the standard local treatment of muscle invasive bladder cancer (MIBC) (T2-T4). In the last decade, the management of MIBC had become multidisciplinary involving peri-operative chemotherapy (neo- or adjuvant chemotherapy). Randomized trials and meta-analyses confirmed the survival benefit of neoadjuvant chemotherapy before local treatment (surgery and/or radiotherapy). Consequently, this sequence should be considered as standard treatment of choice, for patients with good performance status (0-1) and good renal function. The benefit of adjuvant chemotherapy is not clear for patients treated with primary surgery.