Place actuelle de la chimiothérapie dans le traitement des cancers infiltrants de vessie

: Treatment of bladder carcinoma with cystectomy and or radiotherapy provide 5-year survival rates of 28-50%. Phase II chemotherapy trials have proven its efficacy with a partial and complete response rate of 20% and 10% respectively for drugs such as cisplatin or methotrexate. Recent phase III studies have demonstrated the superiority of associations such as CMV, CISCA or M-VAC with complete response rates of 28-39%. Neoadjuvant chemotherapy may increase local control and offer the possibility of conservative treatment after complete tumor regression (one third of cases). The positive effect of neoadjuvant chemotherapy on survival has not yet been demonstrated and randomized trials are now in progress. The concomitant association of cisplatin or fluorouracil with radiation therapy provides high complete response rates (65-88%) in all published studies. A longer follow-up period is necessary to confirm these results in terms of local control gain and survival benefit, but this strategy seems to constitute a major advancement for patients unable to undergo radical cystectomy. Further studies are needed before extending this conservative approach to less advanced invasive bladder carcinoma. Adjuvant chemotherapy may decrease metastasis rate, but survival benefit has not yet been definitively established by randomized studies.