Neo-adjuvant chemotherapy in invasive bladder cancer

In patients with locally advanced muscle-invasive bladder cancer, neo-adjuv ant chemotherapy was designed to treat micrometastatic disease present in u p to 50% of patients at the time of diagnosis. Early chemotherapy has been combined with local therapy based on the reasoning that treatment of small volume disease would result in a better outcome. Another reason for giving neo-adjuvant chemotherapy is in an attempt to save the bladder. In selected patients, bladder preservation can be achieved with the use of chemotherap y plus radiotherapy, partial cystectomy, or transurethral resection of the bladder (TURB). Neo-adjuvant chemotherapy and bladder preservation remain c ontroversial topics, as radical cystectomy is still considered to be the go ld standard of treatment for muscle-invasive bladder cancer. The true succe ss of bladder-preserving treatment by chemotherapy with or without RT will require validation in prospective randomized trials.