The current and future application of adjuvant systemic chemotherapy in patients with bladder cancer following cystectomy

Urothelial transitional cell cancer has a high rate of response (>= 50%) to combination cytotoxic therapy, especially regimens that are designed around cisplatin. Approximately 50% of patients with high-grade bladder cancer and deep muscle invasion ultimately die of disseminated disease. High-risk patients with pT3-pT4 and node-negative disease have no more than a 5-year overall survival of 47% after cystectomy; patients with lymph node metastases have an overall 5-year survival rate of up to 31% after radical cystectomy [1,2]. However, translating the high response seen in locally advanced disease into long-term survival in the metastatic setting and to improved survival in the advanced setting has proved difficult [3,4]. This article reviews the use of adjuvant chemotherapy in localized or locally advanced transitional cell cancer. The chemotherapy of urological malignancies, including bladder cancer, has recently been reviewed in detail [5]; this article does not contain an extensive review of the drugs used.