Radiotherapy and chemotherapy for invasive bladder cancer.

Invasive bladder cancer is associated with locoregional and distant metastases. To improve the outcome of management, systemic chemotherapy has been combined with locoregional treatment. Programmes have been structured in which chemotherapy is administered before or after definitive radiotherapy or surgery, or in combination with radiotherapy. Most randomized trials to date have failed to define a survival benefit from initial chemotherapy, but evidence is emerging that classical adjuvant chemotherapy may improve survival. New cytotoxic agents, including paclitaxel and gemcitabine, accompanied by an emerging understanding of the factors governing cytotoxic drug resistance, may also lead to better management.