What are treatment protocols for muscle-invasive bladder cancer without metastatic disease?

Updated: Feb 23, 2021
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: E Jason Abel, MD  more...
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TURBT is the initial treatment recommendation to help identify the stage of the bladder cancer.

All muscle-invasive tumors are categorized as high-grade urothelial carcinomas. [11]

Radical cystectomy is the primary treatment for T2 and T3 tumors, with consideration for neoadjuvant chemotherapy.

Clinical evidence has demonstrated a overall survival benefit of neoadjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), compared with cystectomy alone. [12]

Current clinical data conflict on the role of adjuvant therapy in invasive bladder cancer, and additional trials are required; however, results from trials show delays of recurrence, so chemotherapy with MVAC or gemcitabine and cisplatin may be used (see chemotherapy for drug regimens. [1]

While no randomized studies have been performed comparing neoadjuvant with adjuvant therapy, many centers prefer to administer chemotherapy only after cystectomy and pathologic staging (ie, adjuvant therapy).

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