[Preoperative chemotherapy in genitourinary cancer]

Preoperative chemotherapy is the standard therapy for metastatic testicular cancer, and is also a candidate for a new treatment modality in management of bladder cancer. Since the advent of cisplatin-based chemotherapy in the late 1970s, a majority of metastatic testicular cancer patients can be made disease-free and cured with chemotherapy followed by surgery. The development of combination chemotherapy including cisplatin and methotrexate in the late 1980s also improved the tumor regression rate for bladder cancer. However, the chemotherapy for the metastatic bladder cancer can not control a relapse after initial response, nor improve the survival rate, significantly. While several pilot studies suggest that the neoadjuvant chemotherapy may be beneficial in non-metastatic invasive bladder cancer, the results of randomized trials are presently not available to define the role of this new treatment modality in management of bladder cancer. Intra-arterial chemotherapy combined with radiotherapy and conservative surgery may be indicated for selected patients as bladder preservation therapy.