Neoadjuvant chemotherapy in the management of muscle-invasive bladder cancer.

Muscle-invasive bladder cancer is typically an aggressive solid tumor with the propensity for early systemic dissemination. Although radical cystectomy remains the gold standard intervention, the high rate of systemic failure has prompted investigators to evaluate various strategies to attempt to improve survival, including the early administration of systemic chemotherapy. These efforts have provided mixed results with two recently completed trials providing conflicting results. Other strategies include attempts to both preserve the bladder using combinations of limited surgical resection, systemic chemotherapy, and radiotherapy. This review focuses on the potential of neoadjuvantly administered therapies to impact the management of muscle-invasive bladder cancer.