Neoadjuvant vs. Adjuvant Chemotherapy: Which Is Right?
Muscle invasive bladder cancer which has not yet spread outside the bladder presents a very high risk of subsequent death from metastatic disease. It also presents the opportunity to cure by aggressive, multimodal therapy. Whilst a radical treatment approach to the bladder (either by cystectomy or by radical radiotherapy with or without concomitant radiosensitization) is fundamental, as the most lethal risk is from systemic disease, there is a clear role for systemic therapy around the time of radical treatment. The strongest data support the use of chemotherapy before surgery or radiotherapy (neoadjuvant), but this is not always feasible and so adjuvant chemotherapy after cystectomy presents an alternative treatment approach, albeit the data to support adjuvant therapy are less strong. How best to choose patients for neoadjuvant, adjuvant or, indeed, no systemic therapy remains controversial and uncertain.
KeywordsAdjuvant Cisplatin Neoadjuvant Muscle-invasive Variants
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