[Neoadjuvant chemotherapy of invasive bladder cancer]

Neoadjuvant chemotherapy is defined as cytotoxic treatment of an invasive carcinoma of the bladder. It is primarily suitable for a curative cystectomy with the aim of improving the therapeutic chances of the definitive treatment (i.e., cystectomy, radiotherapy) by devitalization of the primary tumor and effective control of micrometastases. Thus, one of the major goals is preoperative sterilization of the tumor (stage pT0) to avoid tumor cell seeding during surgery. Until now, the documented pathological complete response rate (CRp) after 2-4 cycles of polychemotherapy has ranged from 19 to 38% plus 3 to 23% of complete surgical response (CRs) with residual superficial bladder tumors in the cystectomy specimen. The survival rates following neoadjuvant polychemotherapy differ considerably between 54 and 82% independent of the definitive treatment (cystectomy, radiotherapy). However, the response to chemotherapy has a significant impact on survival: patients with major pathological response (CRp + CRs) yielded a 75-100% disease-free survival after 4 to 5 years in contrast to 20-22% for partial or non-responders. Future studies should investigate methods predicting the outcome of polychemotherapy (i.e., identifying mdr-chemoresistant tumors by detection of P170 glycoprotein in the TUR specimen) or improving the reliability of preoperative diagnosis (clinical = pathological complete response).