Perioperative therapy for the treatment of high-risk urothelial cancer

Recent developments in the field of perioperative therapy for the treatment of high-risk urothelial cancer are reviewed. A combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) is regarded as the gold standard for the treatment of advanced urothelial cancer. A recent randomized controlled trial revealed that the combined chemotherapy regimen of gemcitabine plus cisplatin (GC) has a similar efficacy to MVAC, but is less toxic. GC will become the standard treatment for advanced metastatic urothelial cancer. Recent reports and metaanalyses have revealed that neoadjuvant MVAC offers a survival advantage over total cystectomy alone. On the other hand, it has not yet been clarified whether adjuvant chemotherapy provides survival benefits or not. Local recurrence either alone or combined with distant metastasis following radical surgery is not such a rare event. Nonrandomized trials of preoperative radiotherapy have suggested improved survival rates. On the other hand, most retrospective studies dealing with postoperative radiotherapy have revealed a significant increase in disease-free survival. However, postoperative radiotherapy for cases of urothelial cancer has remained unpopular due to late intestinal complications. The purpose of this review is to summarize the current evidence supporting the role of perioperative therapy and to reveal the potential future directions for this therapy. (author)