ROLE OF ADJUVANT CHEMOTHERAPY IN THE TREATMENT OF INVASIVE-CARCINOMA OF THE URINARY-BLADDER

Purpose: The standard treatment for patients with muscle-invasive carc inoma of the urinary bladder is radical cystectomy. While radical cyst ectomy cures many patients with this tumor, almost 50% of them will de velop metastatic disease, Adjuvant chemotherapy has been proposed for these patients in an attempt to reduce the probability of relapse and to improve survival. To assess whether adjuvant chemotherapy does bene fit patients with muscle-invasive bladder cancer, we reviewed all phas e II and III studies published in the English literature over the last 20 years. Methods: A review of all published reports was facilitated by the use of Medline computer search and by manual search of the Inde x Medicus, Results: Several comparative, nonrandomized studies have in dicated that adjuvant chemotherapy may prolong disease-free survival, Four randomized studies have been conducted and all had a suboptimal p atient accrual, Three studies used a cisplatin-containing combination chemotherapy and included primarily patients with non-organ-confined t ransitional-cell carcinoma (TCC) of the bladder, All three studies ind icated that adjuvant chemotherapy improved disease-free survival and t wo of them also showed improvement in event-free survival and overall survival, respectively, Conclusion: Published series have been unable to establish an undisputed benefit of adjuvant chemotherapy over radic al cystectomy alone for muscle-invasive bladder cancer, The interpreta tion of the available data is compromised by several methodologic and statistical problems, Thus, adjuvant chemotherapy cannot be considered as a standard treatment for all patients with muscle-inversive carcin oma of the bladder, Well-designed prospective randomized studies are n eeded to clarify the role of adjuvant chemotherapy in this disease. Ho wever, outside a protocol setting, there is some evidence that patient s with extravesical disease or with lymph node involvement may benefit from adjuvant treatment with cisplatin-based combination chemotherapy . No data support such an approach for patients with muscle-invasive b ut organ-confined bladder cancer, (C) 1998 by American Society of Clin ical Oncology.