There have been more studies of chemotherapy with single and combination drug regimens, before and/or after surgery or radiation therapy . If used before surgery (neoadjuvant), the aim is to decrease tumor size, increase the chance for a surgical cystectomy, destroy any tiny metastases that later seed the body but cannot be seen on x-rays or other imaging studies, predict good-risk versus poor-risk cases, lead eventually to bladder preservation (no need for removal of the bladder and creation of a pouch) and, more important, increase survival.
Some studies in limited numbers of patients suggest benefit with neoadjuvant chemotherapy combined with either surgery or radiation therapy, but others have found only increased toxicity. The value of preoperative chemotherapy is being tested in the United States and Europe. Until the results are known, preoperative chemotherapy must still be considered investigational.
Patients with large bladder lesions (T4), nodal involvement (N+) or disseminated disease (M+) should be offered chemotherapy.
Laser Therapy Superficial cancers can be treated by laser vaporization-coagulation with Nd:YAG
or carbon dioxide (CO2)lasers.
Combination Therapy Therapy with preoperative and/or postoperative radiation has not been found to be as effective in improving survival as previously thought and has been abandoned in many cancer centers. The real problem after a cystectomy is the appearance of distant metastases in over two-thirds of patients despite
