Adjuvant chemotherapy and neoadjuvant chemotherapy for bladder cancer

Adjuvant chemotherapy is chemotherapy after surgery. For patients with clinical muscle-invasive bladder cancer, if the pathology after radical cystectomy shows positive lymph nodes, adjuvant chemotherapy can be used after surgery if neoadjuvant chemotherapy was not performed before surgery. If the pathology after partial cystectomy shows positive lymph nodes or positive resection margins, adjuvant chemotherapy can also be used after surgery. Adjuvant chemotherapy can delay disease progression and prevent recurrence.

Neoadjuvant chemotherapy for bladder cancer is chemotherapy before surgery. For patients with operable muscle-invasive bladder cancer, neoadjuvant chemotherapy can be performed before surgery. The main purpose of neoadjuvant chemotherapy is to control local lesions, downstage the tumor, reduce the difficulty of surgery, eliminate micrometastases, and improve long-term survival after surgery. After neoadjuvant chemotherapy, the mortality rate of patients can be reduced by 12% to 14%, the 5-year survival rate can be increased by 5% to 7%, and the distant metastasis rate can be reduced by 5%.

Chemotherapy is usually carried out by intravesical instillation of drugs. Commonly used drugs include mitomycin, doxorubicin, hydroxycamptothecin and BCG. The drugs are instilled once a week, and a course of treatment is 8 times. BCG is currently considered to be the most effective, but the incidence of adverse reactions such as fever, bladder irritation symptoms, and hemorrhagic cystitis is relatively high.