Adjuvant cisplatin based chemotherapy after definitive local treatment for T2-4 N0-2 bladder cancer is associated with an absolute overall survival benefit of 9% and disease free survival benefit of 12% at 3 years.
Neoadjuvant CMV 3 cycles prior to definitive local treatment for bladder cancer increases overall survival by 7 months corresponding to a 3 year survival increase from 50% to 56% and a 10 year increase from 30% to 36%.
T1G3 bladder cancer has a high risk of progression and as such a second resection is imperative to reduce understaging and early cystectomy with ileal neobladder is safe and improves disease specific survival.
Muscle invasive bladder cancer is best treated by radical cystectomy extended pelvic node dissection and continent ileal neobladder with consideration of either neoadjuvant or adjuvant chemotherapy in higher risk patients.
Chemoradiation using 55-64Gy with fluorouracil and mitomycin C confers a 12% improvement in locoregional disease-free survival than radiation alone as bladder preserving primary treatment for muscle invasive bladder cancer.