Locally advanced bladder cancer represents a heterogenous spectrum of diseases with different biologic and clinical behavior. It varies with respect to invasive potential, propensity for metastasis, and sensitivity to chemotherapy. Although several significant surgical advances have been made over the past 20 years in the treatment of muscle-invasive bladder cancer, resulting in decreases in perioperative morbidity and mortality and improvement of quality of life in patients with continent urinary diversions, the natural history of the disease has remained unaltered. Advances in chemotherapy for metastatic disease have prompted trials of systemic therapy in patients with early stage, high-risk disease administered before or after local therapy consisting of cystectomy or radiotherapy. Even if neoadjuvant chemotherapy does not improve survival, preliminary data suggest that bladder preservation may be possible in selected patients. In view of small sample size, confusing analyses, and the reporting of questionable conclusions, trials of postoperative chemotherapy have provided insufficient evidence to support the routine use of adjuvant chemotherapy in clinical practice.

        Key words: locally advanced urinary bladder cancer - therapy.