A prospective randomized trial for postoperative vs. preoperative adjuvant radiotherapy for muscle-invasive bladder cancer

Radiothérapie périopératoire dans la prise en charge des tumeurs urothéliales infiltrantes de la vessie (TVIM) : une indication à reconsidérer ?

“…Par la suite, deux études non randomisées effectuées sur une population atteinte de carcinomes urothéliaux ont retrouvé des résultats identiques [45,46]. Plus récemment, une étude égyptienne prospective randomisée a comparé l'utilisation de la radiothérapie pré-opératoire à la radiothérapie adjuvante [47], avec un même schéma d'irradiation dans les deux bras (50 Gy en 25 fractions). La moitié des patients inclus présentait une tumeur pT3.…”

“…A contrario, Zaghloul et al [43] n'ont observé que 18 % de toxicité digestive tardive chez les patients traités par radiothérapie adjuvante en FC et seulement 5 % en cas de radiothérapie en HF. Dans l'étude égyp-tienne comparant une irradiation préopératoire et adjuvante [47], 6,5 % de toxicité intestinale tardive de grade 3 sont survenues. Aucune toxicité de grade 4 n'était retrouvée.…”

Re-evaluation of the value of adjunctive modern radiotherapy in muscle-invasive bladder cancer

“…This unsatisfactory image was either due to insignificant improvement in the published survival rates or due to the fear of high and unacceptable late complications [2] . Abd El-Moneim et al [1] achieved 5-year overall survival of 51% as 89% of their patients belonged to the clinical categories T3 and T4. They showed clearly that there was no difference between the 2 randomized groups; in overall survival, disease-free survival, local control and distant metastasis-free rates.…”

“…This big difference in radiation volume led to the discrepancy in the reported late GIT and therefore the hesitancy of the oncology community to re-investigate the value of post-operative radiotherapy after radical cystectomy. Obviously, Abd El-Moneim et al [1] emphasized the previously reported mild complication rates [2][3][4] and concluded that pre-and post-operative radiotherapy was tolerable and safe. This report though being the first comparing these 2 modalities of radiation, yet it used a conventional 2D technique with 3 fields arrangement.…”

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A controlled prospective randomized study was recently published; comparing pre-and post-operative radiotherapy in bladder cancer patients [1] . This study was the first to compare these radical cystectomy adjunctive radiation methods.

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