Chemotherapy before or after surgery is not commonly used as a clinical practice, which is contrary to the treatment guidelines for high risk bladder cancer

Use of chemotherapy before surgery remained stable (an average of 4 percent of patients) over the study period, which is surprising given the evidence that this is a standard of care that has been demonstrated to improve survival. The use of chemotherapy after surgery increased over time: 16 percent of patients in 1994 to 1998, 18 percent in 1999 to 2003, and 22 percent in 2004 to 2008. Study results showed that use of chemotherapy after surgery was associated with better survival.
"Results from our study demonstrate that chemotherapy given after surgery improves patient survival—probably on the same order of magnitude as chemotherapy before surgery," said Dr. Booth. "Patients having surgery for bladder cancer should have chemotherapy, either before or after surgery. Efforts are needed to improve uptake of this treatment, which appears to be vastly underutilized."
Source-Eurekalert