The Role of Neoadjuvant Chemotherapy in Bladder Preservation Approaches in Muscle-Invasive Bladder Cancer.

Neoadjuvant chemotherapy (NAC), which aims to eliminate micrometastatic disease, has been established as the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). This is based on randomized controlled trials showing a survival benefit of NAC prior to RC compared to RC alone. It was anticipated that a similar survival benefit would also be seen when NAC was given prior to bladder preserving approaches, but the e phase III RTOG 8903 study which explored this concept was reported to be a negative study. However, there are a number of important caveats to be considered. First, the profile of patients opting for bladder preservation has changed from the older, frailer non-surgical candidates, to now also include younger, fitter patients opting for bladder preservation and who are also more likely to tolerate NAC. In recent years, there have also been important advances in systemic chemotherapy, immunotherapy, radiation techniques, and supportive care. As such revisitng the role of NAC prior to bladder preserving approaches in MIBC appears warranted.

Seminars in radiation oncology. 2023 Jan [Epub]

Carlos Stecca, Timur Mitin, Srikala S Sridhar

Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada., Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon., Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada. Electronic address: .