الفهرس 
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Abstract
Bladder cancer is the most common malignancy involving the urinary system. Urothelial (transitional cell) carcinoma is the predominant histologic type in the United States and Europe. Radical cystectomy with bilateral pelvic lymphadenectomy are the treatment of choice for patients with muscle-invasive bladder cancer. However, many cases relapse after cystectomy alone for patients with muscle invasive bladder cancer. Contemporary treatment of patients with muscle invasive bladder cancer consists of a multimodal treatment approach includes surgery, neoadjuvant chemotherapy, and for some patients, chemo radiation with the for bladder preservation. However, In spite of the evidence that neoadjuvant cisplatin based chemotherapy improves survival for these patients compared to surgical treatment alone, less than 20% of patients undergoing radical cystectomy actually receive neoadjuvant chemotherapy, the optimal regimen has yet to be determined. This study was conducted on newly diagnosed patients with muscle invasive bladder cancer, All patients were given neoadjuvant chemotherapy gemcitabine /cisplatin protocol. Both SCC, and TCC showed good response to the neoadjuvant chemotherapy protocol M VAC. The administration of gemcitabine /cisplatin as a neoadjuvant seems to be well tolerated. The overall survival was better in patients who underwent surgery compared to those who received definitive radiotherapy. At the end of this study, we concluded that utility of neoadjuvant chemotherapy protocol gemcitabine /cisplatin is considered safe and effective in MIBC whatever the histologic variant of bladder cancer. Finally, we confirmed the safety and efficacy of gemcitabine/ cispaltin protocol as neoadjuvant chemotherapy in muscle invasive bladder cancer, further phase III studies in comparison to other protocols are recommended to conclude the ideal neoadjuvant regimen.