Urothelial cancer has long been recognized as a chemoresponsive neoplasm, with combination therapy based on a cisplatin backbone, considered the mainstay of treatment. In the past year, ifosfamide and taxol were added to the list of effective agents, and the activity of a new combination, vinblastine, ifosfamide and gallium nitrate, was also reported as effective in patients. For patients with invasive tumors, standard treatment is radical surgery; however, an examination of results using approaches other than radical cystectomy shows that, in selected cases, safe organ preservation can be achieved. The prospective application of recognized prognostic factors, both clinical and pathologic, hopefully will improve case selection. This will permit the use of systemic therapies for those who require it most, and allow consideration of organ-preservation approaches for those with a low risk of recurrence, progression, and metastases.
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