Postoperative radiation therapy for muscle‐invading bladder carcinoma

Abstract

From 1974-1980, 15 patients with pT2-4 bladder carcinoma received adjuvant postoperative radiation therapy (XRT). The extent of initial surgery varied (six radical cystectomy, 5 partial cystectomy, four "total" transurethral resection). The planned XRT was 4,000-5,040 rads in 5-6 weeks to the pelvis (achieved in 14/15 patients) followed by a bladder boost in noncystectomized patients (achieved in 8/9). Survival at two years and five years was 54% (7/13 patients) and 27% (3/11 patients), respectively. Local-regional disease control (minimum two-year follow-up) was achieved in 7/11 (63%). Of seven patients alive at least two years later, small bowel complications (chronic diarrhea, obstruction) occurred in two; these latter patients each had had radical cystectomy. Adjuvant postoperative XRT may be useful in the multimodality management of patients with bladder carcinoma, especially those identified as high risk after pathologic staging and initial surgery. The poor regional control rate and relatively high incidence of complications seen in this and previous studies suggest that improved radiation technique is needed, both to ensure adequate coverage of the volume at risk and to minimize complications. Representative portals are shown to illustrate these features.

Adjuvant Sandwich Chemotherapy Plus Radiotherapy vs Adjuvant Chemotherapy Alone for Locally Advanced Bladder Cancer After Radical Cystectomy

“…Unlike the studies from the 1970s and 1980s in the United States using older RT techniques that reported relatively high late GI tract adverse effects, the present trial (the first to use modern 3-D conformal RT after RC) found that adjuvant RT was reasonably well tolerated. Acute and late grade 3 GI toxicity was not appreciably different between the arms, and a comparable percentage in each arm completed the prescribed therapy.…”

“…Eighty percent had squamous cell carcinoma (SCC), and only 20% had urothelial carcinoma, but the outcomes were the same regardless of histology. That trial, which used older 2-dimensional RT techniques, established adjuvant RT as a standard treatment for locally advanced disease in Egypt; however, postoperative RT has no defined role outside of the Middle East, largely because of the adverse effects reported in several small series using pre-1980s treatment techniques and concerns about the applicability of the Egyptian trial for urothelial carcinoma.…”