See the recent updates on bladder cancer here and here

Most bladder cancers are very superficial and are treated with limited surgery or intravesical chemotherapy (chemotherapy drugs or BCG put directly into the bladder through a catheter, see NCCN guidelines for  treatment and the risk of relapse or progression.)  Chemoradiation may be an option for high risk early patients (go here).

Patients with more advanced cancer are usually treated with major surgery (usually removing the bladder.) Radiation alone may cure only about 25% of the cases, but  radiation combined with chemotherapy may cure more, and there has been an increase in the use of bladder preservation therapy (avoiding a cystectomy.) (see the videos.)  Chemotherapy is often very effective for bladder cancer and is being used more frequently.

The usual chemotherapy regimen is MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) or other regimens like gemcitabine, cisplatin are as effective (J Clin Onc 2000;17:3068.) with response rates in the 40% range and median survivals of 12 - 14 months with advanced or metastatic disease. Most patients with advanced bladder cancer will receive neoadjuvant (chemo before surgery) or adjuvant MVAC (after surgery) with studies showing this pushes up the survival rate from 20-30% up to 52-58% (J Clin Onc 2001;19:4003.)  The choice between radical cystectomy and chemo-radiation is controversial, see the NCCN guidelines above  Some recent studies on the role or radiation or radiation plus chemotherapy are shown here and a recent chemo-radiation protocol and review , an other review of the results of chemoradiation for muscle invading bladder cancer here, and large bladder radiation series from Rodel.