Grossman - Figure 29
Conclusion
FIG. 29: In conclusion, neoadjuvant chemotherapy improves survival in muscle-invasive bladder cancer. This is supported by Level I evidence, by the results of meta-analyses, and in guidelines issued by both the AUA[11] and the EAU.[10] There is no question that neoadjuvant chemotherapy is associated with toxicity, and therefore clinical judgment (as in most medical problems) is important.
If patients cannot tolerate cisplatin-based combination chemotherapy, then going immediately to definitive therapy may be more appropriate. However, for patients who can tolerate cisplatin-based combination chemotherapy, the data show that survival can be improved.
Finally, collaboration between urologic surgeons and medical oncologists is essential to increase the use of neoadjuvant chemotherapy in patients who require this potentially life-saving treatment.
References
Witjes JA, Lebret T, Compérat EM, et al. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. 2017;71:462–75 http://dx.doi.org/10.1016/j.eururo.2016.06.020
Chang SS, Bochner BH, Chou R, et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol. 2017;198:552−9 http://dx.doi.org/10.1016/j.juro.2017.04.086
