Radical cystectomy associated with bilateral pelvic lymphadenectomy is the elective treatment for infiltrating urothelial carcinoma. Although it may be curative, about 50% of patients have recurrences after 2 years, generally at a systemic level. Pelvic node recurrence, however, accounts for a certain rate of mortality. With regard to prognosis, the most important factor for survival is the stage, with overall survival at 5 years varying from 60–80% for pT2 lesions down to 0–18% for pT4 lesions and for patients with positive lymph nodes from 4 to 30%. Adjuvant and neo-adjuvant chemotherapy programmes have therefore been developed in an attempt to improve the percentages of recurrences and of overall survival and perhaps later to increase the possibilities of organ preservation. Chemotherapeutic indications in metastatic and locally advanced disease are therefore reviewed.
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