Chemotherapy given before surgery or radiotherapy is called neoadjuvant chemotherapy. Neoadjuvant chemotherapy can reduce the risk of bladder cancer coming back. But chemotherapy can also cause side effects so it is not suitable for everyone.

Studies have compared giving people with bladder cancer neoadjuvant chemotherapy to giving surgery or radiotherapy on its own. The studies found that 5 years after treatment, the cancer came back in 5% fewer people in the group who had neoadjuvant chemotherapy.

It isn't possible to say which chemotherapy drugs work best as neoadjuvant treatment. This is because the studies looked at different combinations of chemotherapy. Combinations that have been researched include

• MVAC (methotrexate, vinblastine, adriamycin, cisplatin)
• GC (gemcitabine and cisplatin)
• CMV (cisplatin, methotrexate and vinblastine).

Although giving neoadjuvant chemotherapy can help to reduce the risk of cancer coming back it isn't the right treatment for everyone. For some people the problems that chemotherapy causes are greater than any benefit they may get from it. Because of this, doctors are looking at ways to help them predict who is most likely to benefit from neoadjuvant chemotherapy. Clinical trials are being run to look for new combinations of chemotherapy drugs that are as effective as those used now but cause less side effects.

So, neoadjuvant chemotherapy may not be the best treatment for you if you are elderly, have other health problems, or the risk of the cancer coming back is low.

The other reason doctors may consider neoadjuvant chemotherapy before surgery is to shrink tumours in the bladder. This may help to make the operation simpler or may make it possible to keep some of the bladder. It isn't known yet how successful it is to use neoadjuvant chemotherapy in this way. So it remains experimental and may be offered to people as part of a clinical trial.

Before someone has an operation to remove their bladder all aspects of their treatment should be discussed in a multidisciplinary team (MDT). MDTs are made up of doctors who specialise in chemotherapy and radiotherapy as well as surgeons. MDTs help to make sure that issues are fully considered, such as which treatments are best for a person and when they should be given. Your specialist will be able to tell you if they are part of a MDT and whether chemotherapy has been considered in your case.

Reference

• Cochrane Database of Systematic Reviews 2005 April 18(2)CD005246