Interview with Dr. Maria De Santis at ESMO 2014
The optimal combination of local and systemic therapy is essential to obtain longer term survival. Level of evidence for adjuvant chemotherapy is limited and trials available on adjuvant chemotherapy are flawed are had problems with accrual. Neoadjuvant chemotherapy is now recommended by the EAU guidelines. Adjuvant chemotherapy is optional according to the EAU-guidelines. No head-to-head comparisons of cystectomy versus radiotherapy are available. Three randomized compared the use of radiotherapy and chemotherapy. 5FU and mitomycine C showed improved survival in combination with radiotherapy in a recent trial published in the New England Journal of Medicine. Trimodality using TURT, chemotherapy and radiotherapy may be comparable to cystectomy in selected patients but randomized studies in this field are lacking. Chemotherapy alone is not recommended. Radiation, such as hypofractionated schemes is a valuable option for palliation in non-operable muscle invasive bladder cancer.