Neoadjuvant chemotherapy for invasive bladder cancer.

Overview

Neoadjuvant chemotherapy is being integrated increasingly into the primary therapy for locally advanced bladder cancer. The rationale is due to the favorable responses observed in patients with metastatic bladder cancer, the high systemic relapse rate after apparent local control with either surgery or radiotherapy, the potential for using the bladder lesion as a indicator for selecting patients responsive to chemotherapy, and the ultimate possibility of bladder preservation. While neoadjuvant chemotherapy can induce significant clinical and pathologic tumor regression, such experiences have exposed multiple variables involving bladder tumor heterogeneity, patient selection, and investigator evaluation that raise serious questions regarding the overall efficacy of neoadjuvant therapy.