Combined preoperative and postoperative radiation for bladder cancer. Results of RTOG/Jefferson study

Abstract

Ninety‐two patients with bladder cancer have been treated with combined pre‐ and postoperative radiation in a Radiation Oncology Study Group (RTOG) Phase I–II study and at Thomas Jefferson University Hospital. Patients with invasive bladder cancer were entered into the study and given lowdose preoperative radiation (500 rad) to the whole pelvis, either on the day of or the day before cystectomy. Following surgery, patients were pathologically staged. Patients with stage B1 (T2) (grade 3 or 4), stage B2 and C (T3) tumors were given 4500 rad in 5 weeks postoperative radiation. Follow‐up in the study ranges from a minimum of 24 months to 5 years, with a median of 36 months. Incidence of complications was 15% (14/92). The 4‐year actuarial survival (Kaplan‐Meier) by stage of disease is 68% for stage B1 (T2) (grade 3 or 4), 78% for stage B2, and 57% for stage C. These survival results appear to be better than those obtained with other approaches of adjuvant therapy and/or surgery in comparable histopathologically staged patients.

Bladder Preservation Strategies

“…14,15 Postoperative radiotherapy remains an active area of investigation (in the context of modern treatment techniques) with several ongoing singleinstitution phase II studies as well as a randomized phase II protocol being developed by the NRG cooperative group/National Cancer Institute clinical trial network in patients with pT3/4 and/or pN1 disease. 7,16 Surgery Plus Chemotherapy Neoadjuvant chemotherapy with surgery has several theoretic advantages: early therapy for potential micrometastases, drug delivery not being compromised by an altered surgical bed, and improved tumor resectability.…”

“…[14][15][16][17] Although the addition of radiotherapy with surgery (in either the preoperative or postoperative study) is not currently standard, the addition of neoadjuvant (and probably adjuvant) chemotherapy with surgery has been demonstrated to improve survival. The combination of surgery and chemotherapy is now the optimal standard in patients suitable for cisplatin-based multidrug therapy from the standpoint of cancer control outcomes, with a 5-year overall survival of approximately 70% for muscle-invasive disease.…”