Nutrfs11/25/2023 ![]() ![]() However, some patients who do not undergo neoadjuvant therapy may have evidence of high-risk disease at cystectomy and are at risk for worse outcomes. (See "Neoadjuvant treatment options for muscle-invasive urothelial bladder cancer".) Neoadjuvant chemotherapy remains the preferred approach for these patients because it is associated with a survival advantage, and approximately 30 percent of patients experience complications or slow recovery following radical cystectomy that preclude them from receiving adjuvant chemotherapy. Rationale for adjuvant chemotherapy - The role of adjuvant chemotherapy in patients with muscle-invasive urothelial bladder cancer has not been established in fully accrued, adequately powered randomized trials. (See 'Patients who received neoadjuvant chemotherapy' below.) The approach to adjuvant therapy in those with high-risk pathologic features at cystectomy who have previously received neoadjuvant therapy is discussed below. Patients with these tumor characteristics should be further evaluated for eligibility of adjuvant cisplatin-based combination chemotherapy. High-risk characteristics for this patient population include tumor that extends beyond the muscle (pathologic T3 or T4 disease ( table 1)) and/or pathologic node involvement. Patient selection - Patients with high-risk tumor features who did not receive neoadjuvant chemotherapy are appropriate candidates for adjuvant chemotherapy, as long as no contraindications to cisplatin are present ( algorithm 1). Patients who did not receive neoadjuvant chemotherapy (See "Malignancies of the renal pelvis and ureter", section on 'Treatment of localized disease'.)ĭECISIONS REGARDING ADJUVANT CHEMOTHERAPY.(See "Bladder preservation treatment options for muscle-invasive urothelial bladder cancer", section on 'Concurrent chemoradiation'.).(See "Neoadjuvant treatment options for muscle-invasive urothelial bladder cancer".).(See "Overview of the initial approach and management of urothelial bladder cancer".).Surgical approaches, the role of neoadjuvant chemotherapy, the use of bladder-sparing chemoradiotherapy in bladder cancer, and management of urothelial carcinomas of the upper urinary tract are discussed separately: The role of adjuvant chemotherapy, adjuvant immunotherapy, and adjuvant radiation in patients with locally advanced urothelial carcinoma of the bladder will be reviewed here. As a result, some clinicians and patients opt for initial treatment with definitive surgery rather than neoadjuvant chemotherapy, reserving the option of adjuvant treatment for those at high risk for recurrence based on pathologic staging. This raises the concern that some may be overtreated. Neoadjuvant chemotherapy is associated with a survival advantage for patients with locally advanced bladder cancer relative to no chemotherapy, but clinicians are not yet able to identify those patients most likely to benefit from treatment. The identification of active chemotherapy regimens in patients with metastatic urothelial carcinoma has resulted in the use of both neoadjuvant and adjuvant chemotherapy. (See "Epidemiology and risk factors of urothelial (transitional cell) carcinoma of the bladder", section on 'Epidemiology'.) ![]() In other areas of the world, non-urothelial carcinomas are more frequent. Urothelial (transitional cell) carcinoma is the predominant histologic type, particularly in the United States and Europe, where it accounts for 90 percent of all bladder cancers. INTRODUCTION - Bladder cancer is the most common malignancy involving the urinary system. ![]()
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