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1、TheRoleofPerioperativeChemotherapyintheTreatmentofUrothelialCanceraDepartmentofMedicine,DivisionofHematology/OncologyandbDepartmentofRadiationOncology,St.Luke’s-RooseveltHospitalCenter,NeentofMedicine,DivisionofHematology/OncologyanddDepartmentofUrology,BethIsraelMedicalCenter,NeCancerC
2、entersofNea;Neoadjuvant;Adjuvant;ChemotherapyABSTRACTCanceroftheurotheliumisthefourthmostmonmalignancyinmenintheU.S.andtheninthmostmoninen.Morethan63,000Americansenand16,200en),andmorethan13,000(8,970menand4,210en)canexpecttodieoftheirdisease.Theapproximate5:1ratioofincidencetomortality
3、roughlyparallelsthefrequencyofsuperficialtoinvasivedisease.Effortstoimprovethisratiohavegeneratedapotentialparadigmshiftinthetreatmentofurothelialcancer,incorporatingincreasinglyactivechemotherapyintotreatmentregimensforhigh-risktumorsinboththepre-andpostoperativesettings.Thisreviemariz
4、estheevolutionofchemotherapeutictreatmentofurothelialcancerandtherationaleforitsperioperativeadministrationandaddressesthefuturedirectionsofclinicalresearchinthisfield.INTRODUCTIONCanceroftheurotheliumisthefourthmostmonmalignancyinmenintheU.S.andtheninthmostmoninen[1].Morethan63,000Amer
5、icansenand16,200en),andmorethan13,000(8,970menand4,210en)canexpecttodieoftheirdisease[1].Theapproximate5:1ratioofincidencetomortalityroughlyparallelsthefrequencyofsuperficialtoinvasivedisease[1].Effortstoimprovethisratiohavegeneratedapotentialparadigmshiftinthetreatmentofurothelialcance
6、r,incorporatingincreasinglyactivechemotherapyintotreatmentregimensforhigh-risktumorsinboththepre-andpostoperativesettings.Thisreviemarizestheevolutionofchemotherapeutictreatmentofurothelialcancerandtherationaleforitsperioperativeadministrationandaddressesthefuturedirectionsofclinicalres
7、earchinthisfield.RATIONALE:POOROUTESENTALONETumorsthatinvadethedeepmusclelayerofthebladderareassignedstageT2,entofmuscle-invasivecancershashistoricallyprisedsurgicalresectionviaradicalcystectomy,achieving5-yearrecurrence-freesurvivalratesof81%,68%,47%,and44%forpathologicT2,T3a,
