Neoadjuvant and adjuvant chemotherapy for muscle invasive bladder cancer

Muscle invasive bladder cancer (MIBC) is a agresive tumor with a high rate of early sysemic dissemination. Primary treatment of MIBC is radical cystectomy and pelvic lymph node dissection. Prognosis depends on pathological stage and nodal status and five years survival rates vary 70-80% organ confined disease to 20-30 % extravesical disease or node positive disease. Death from MIBC due to distant metastases, therefore it is important to treat micrometastatic disease. Cisplatin-based neoadjuvant combination chemotherapy provides a 6% absolute survival benefit at the 10-years (level 1 evidence). On the contrary, there are not a definitive evidence supporting the use of adjuvant chemotherapy. However utilization of neoadjuvant chemotherapy is very low and its use is interestingly lower than adjuvant chemotherapy. The goal of this article is to review the data supporting perioperative chemotherapy and to take attention to neoadjuvant chemotherapy.