PURPOSE: The standard treatment for @entity1 with muscle-invasive @entity150 is radical cystectomy. While radical cystectomy cures many @entity1 with this @entity5 , almost 50% of them will develop @entity3 . Adjuvant chemotherapy has been proposed for these @entity1 in an attempt to reduce the probability of relapse and to improve survival. To assess whether adjuvant chemotherapy does benefit @entity1 with @entity150 , we reviewed all phase II and III studies published in the English literature over the last 20 years. METHODS: A review of all published reports was facilitated by the use of Medline computer search and by manual search of the Index Medicus. RESULTS: Several comparative, nonrandomized studies have indicated that adjuvant chemotherapy may prolong disease-free survival. Four randomized studies have been conducted and all had a suboptimal @entity1 accrual. Three studies used a @entity900 -containing combination chemotherapy and included primarily @entity1 with non-organ-confined @entity1606 ( @entity1606 ) of the bladder. All three studies indicated that adjuvant chemotherapy improved disease-free survival and two of them also showed improvement in event-free survival and overall survival, respectively. CONCLUSION: Published series have been unable to establish an undisputed benefit of adjuvant chemotherapy over radical cystectomy alone for @entity150 . The interpretation of the available data is compromised by several methodologic and statistical problems. Thus, adjuvant chemotherapy cannot be considered as a standard treatment for all @entity1 with muscle-invasive @entity150 . Well-designed prospective randomized studies are needed to clarify the role of adjuvant chemotherapy in this disease. However, outside a protocol setting, there is some evidence that @entity1 with extravesical disease or with lymph node involvement may benefit from adjuvant treatment with @entity900 -based combination chemotherapy. No data support such an approach for @entity1 with muscle-invasive but organ-confined @entity150 .

Role of adjuvant chemotherapy in the treatment of invasive XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity900 :: ('MESH:D002945', 'Chemical') :: ['cisplatin'] @entity150 :: ('MESH:D001749', 'Disease') :: ['carcinoma of the urinary bladder', 'bladder cancer', 'carcinoma of the bladder', 'muscle-invasive bladder cancer'] @entity1606 :: ('MESH:D002295', 'Disease') :: ['transitional-cell carcinoma', 'TCC'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastatic disease']
@entity150 :: (MESH:D001749,Disease) :: ['carcinoma of the urinary bladder']
