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Urologic Oncology pp 1–19Cite as

Peri-operative Chemotherapy for Muscle-Invasive Bladder Cancer

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Abstract

The role of perioperative chemotherapy as an adjunct to radical cystectomy for muscle-invasive bladder cancer has been explored by several landmark randomized controlled trials over the past decades. On the one hand, a meta-analysis of level-I evidence and long-term results from the largest trials support the use of neoadjuvant chemotherapy, which is now advocated as the standard of care by most of the clinical guidelines worldwide. On the other hand, evidence supporting the use of adjuvant chemotherapy is more contentious. Specifically, several meta-analyses identified a survival benefit with the immediate postoperative delivery of cisplatin-based regimen, but the investigators identified multiple methodological limitations in the vast majority of included randomized controlled trials. Nonetheless, the use of adjuvant chemotherapy is currently considered for patients with adverse pathological features at radical cystectomy. The toxicity of both neoadjuvant and adjuvant chemotherapy is acceptable and well-aligned with what expected with cisplatin-based regimens. Given its greater response rate, the methotrexate, vinblastine, doxorubicine, and cisplatin combination is preferentially used in the neoadjuvant setting, while the gemcitabine plus cisplatin combination is more commonly delivered in the adjuvant setting because of its better toxicity profile. However, there is no prospective evidence suggesting a survival superiority of one regimen over the other. Finally, the comparative effectiveness of neoadjuvant vs. adjuvant chemotherapy has been poorly assessed in the current literature. Nonetheless, the only randomized controlled trial indirectly comparing both suggested no survival difference between the pre- and postoperative delivery of cisplatin-based chemotherapy.

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Author information

Authors and Affiliations

  1. Department of Urology, Pitié Salpétrière Hospital, Assistance Publique des Hôpitaux de Paris, University Paris Sorbonne (for seisen and roupret), Paris, France

    Thomas Seisen & Morgan Rouprêt

  2. Department of Urology, CHRU Tours, Faculté de Médecine François Rabelais, Tours, France

    Benjamin Pradère

Authors
  1. Thomas Seisen
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  2. Benjamin Pradère
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  3. Morgan Rouprêt
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Correspondence to Morgan Rouprêt .

Editor information

Editors and Affiliations

  1. Dept. of Urology & Urologic Oncology, Hannover Medical School, Hannover, Germany

    Axel S. Merseburger

  2. Dept. of Urology, University of Regensburg St. Josef Medical Centre, Regensburg, Germany

    Maximilian Burger

Section Editor information

  1. der Universität Regensburg, Oberarzt der Klinik für Urologie, Regensburg, Germany

    Wolfgang Otto

  2. Departement of Urology, Weill Cornell Medical Center, New York, NY, USA

    Shahrokh F. Shariat

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Seisen, T., Pradère, B., Rouprêt, M. (2018). Peri-operative Chemotherapy for Muscle-Invasive Bladder Cancer. In: Merseburger, A., Burger, M. (eds) Urologic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42603-7_25-1

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  • DOI: https://doi.org/10.1007/978-3-319-42603-7_25-1

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  • Print ISBN: 978-3-319-42603-7

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