How do you approach treatment of localized small cell bladder cancer?

Localized small cell bladder cancers often are upstaged at surgery and show aggressive behavior. I offer 3 months of neoadjuvant chemotherapy (Cisplatin and Etoposide), followed by radical cystectomy for most patients who are surgical candidates (see MD Anderson data, Lynch et al, Eur Urology, PMID 22564397). If a patient already had cystectomy, I recommend an adjuvant platinum-based combination for 3 months. There were Mayo Clinic data showing that stage II disease could be managed with cystectomy alone (Choong, Cancer, 2005, PMID 15700264). I reserve this option for selective cases - small, unifocal, and well-defined bladder lesions and for patients who are not platinum candidates. Patients who are not cystectomy candidates are often not ...