ABSTRACT
Introduction Approximately 15% to 20% of patients with bladder cancer presenting with locally invasive disease and 10% to 25% of patients with superficial disease will eventually develop muscle invasion. As discussed elsewhere in this book, the standard and most common definitive treatment for invasive bladder cancer is radical cystectomy. The 5-year disease-free survival rate is 50% to 80% for patients with muscle-invasive disease (pT2) and 20% to 50% for those with nonorgan-confined cancers (pT3-4).1-8 For patients with nodepositive disease, the 5-year disease-free survival rate is 7% to 36%.2-8
Patients with metastatic bladder cancer can be treated with multiagent chemotherapy, with high objective response rates and improved survival, but long-term (>5 year) survival is unusual.9-11
Improved long-term survival has been demonstrated with adjuvant chemotherapy in other solid tumors, such as breast and colon cancer, in which high response rates with cytotoxic chemotherapy are observed in the metastatic setting. This is likely due to a greater sensitivity to chemotherapy of micrometastases present in patients destined for clinical metastatic disease than to the larger tumors present once metastatic disease is diagnosed.
