Chemotherapy for muscle-invasive bladder cancer in the perioperative setting: current standards.

Radical cystectomy remains the gold standard treatment for muscle-invasive bladder cancer. Although surgery achieves excellent local control, within 5 years, almost 50% of patients have a relapse and, subsequently, progression to systemic disease developing. Randomized trials of cisplatin-based chemotherapy regimens in the neoadjuvant setting have shown the potential to improve survival. Suboptimal trial design, insufficient numbers of patients, and lack of standardization of the chemotherapy regimens used have plagued adjuvant studies. Given the lethality of recurrent transitional cell carcinoma of the bladder, perioperative cisplatin-based chemotherapy should be considered a standard of care.