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Combined-modality therapy for bladder cancer

J A McCaffrey1, D F Bajorin, H I Scher

  • 1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.

Oncology (Williston Park, N.Y.)
|October 23, 1997
PubMed
Summary
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Radical cystectomy is standard for advanced bladder cancer, but chemotherapy can improve outcomes and preserve bladder function. Further research is needed to confirm survival benefits and identify optimal patient selection markers.

Area of Science:

  • Urology
  • Oncology
  • Medical Oncology

Background:

  • Radical cystectomy is the standard treatment for locally advanced bladder cancer (T2-T4, N0, M0).
  • Despite local control, over 50% of patients experience recurrence after surgery.
  • Multidrug cisplatin-based chemotherapy shows superiority over single-agent cisplatin, improving disease-free survival in 10-15% of cases.

Purpose of the Study:

  • To evaluate the role of neoadjuvant chemotherapy in conjunction with surgery and/or radiation therapy for bladder cancer.
  • To assess the feasibility of bladder preservation strategies.
  • To identify prognostic factors for optimizing patient selection in combined-modality therapy.

Main Methods:

  • Review of neoadjuvant chemotherapy studies in locally advanced bladder cancer.

Related Experiment Videos

  • Analysis of outcomes including response rates, bladder preservation rates, and survival.
  • Consideration of newer surgical approaches and adjuvant chemotherapy.

    • Main Results:

    • Neoadjuvant chemotherapy yields major responses in at least 50% of patients.
    • Bladder preservation is achievable in 25-50% of patients, particularly those with less invasive disease.
    • Pathologic complete response is a predictor of long-term survival; however, overall survival benefits remain difficult to ascertain.

    Conclusions:

    • Combined-modality therapy, including neoadjuvant chemotherapy, offers a viable alternative for bladder cancer patients committed to bladder preservation.
    • Further research is essential to confirm survival improvements and identify predictive biomarkers for treatment response.
    • Adjuvant chemotherapy may benefit selected high-risk patients, but requires further study.