Perioperative chemotherapy of bladder cancer. Neoadjuvant, inductive and adjuvant strategies

Background. Every year approximately 16,000 patients are diagnosed with muscle-invasive bladder cancer in Germany. The standard procedure in these patients is radical cystectomy with regional pelvic lymphadenectomy. Within the first 2 years after resection up to 50% of patients initially with non-metastatic tumor stages T2-T4a will relapse with lymph node involvement and/or visceral metastases. Methods. Research and analysis of the current literature. Results. To eliminate potential micrometastases the use of perioperative therapeutic concepts in the form of neoadjuvant, inductive and adjuvant chemotherapy is strongly recommended. Despite positive results and high-level evidence from several randomized trials and meta-analyses showing an improved overall survival in favour of bladder cancer patients treated with perioperative chemotherapy, the procedure is currently still underused in Europe. In this review the current data and arguments for and against the various modalities are discussed.