hemotherapy for Bladder Cancer : reatment Guidelines for Neoadjuvant hemotherapy , Bladder Preservation , djuvant Chemotherapy , and Metastatic

o determine the optimal use of chemotherapy in the neoadjuvant, adjuvant, and metastatic setting in patients with dvanced urothelial cell carcinoma, a consensus conference was convened by the World Health Organization (WHO) nd the Société Internationale d’Urologie (SIU) to critically review the published literature on chemotherapy for atients with locally advanced bladder cancer. This article reports the development of international guidelines for the reatment of patients with locally advanced bladder cancer with neoadjuvant and adjuvant chemotherapy. Bladder reservation is also discussed, as is chemotherapy for patients with metastatic urothelial cancer. The conference panel onsisted of 10 medical oncologists and urologists from 3 continents who are experts in this field and who reviewed the nglish-language literature through October 2004. Relevant English-language literature was identified with the use of edline; additional cited works not detected on the initial search regarding neoadjuvant chemotherapy, bladder reservation, adjuvant chemotherapy, and chemotherapy for patients with metastatic urothelial cancer were reviewed. vidence-based recommendations for diagnosis and management of the disease were made with reference to a 4-point cale. Results of the authors’ deliberations are presented as a consensus document. Meta-analysis of randomized trials n cisplatin-containing combination neoadjuvant chemotherapy revealed a 5% difference in favor of neoadjuvant hemotherapy. No randomized trials have yet compared survival with transurethral resection of bladder tumor alone ersus cystectomy for the management of patients with muscle-invasive disease. Collaborative international adjuvant hemotherapy trials are needed to assist researchers in assessing the true value of adjuvant chemotherapy. Systemic isplatin–based combination chemotherapy is the only current modality that has been shown in phase 3 trials to mprove survival in responsive patients with advanced urothelial cancer. A panel of international experts has ormulated grade A through D recommendations for the management of patients with locally advanced and metastatic rothelial cancer on the basis of level 1 to 3 evidence and the findings of phase 2 trials, prospective randomized clinical rials, and meta-analyses. UROLOGY 69 (Suppl 1A): 62–79, 2007. © 2007 Elsevier Inc.