Randomized Trial of Cystectomy With or Without Preoperative Radiotherapy for Carcinoma of the Bilharzial Bladder

Abstract

A prospective randomized clinical trial was done for 92 patients with carcinoma of the bilharzial bladder who underwent radical cystectomy alone or with 2,000 rad preoperative radiation. The postoperative mortality and morbidity were similar in both groups. Patients were followed for a minimum of 60 months. Over-all, there was a marginal, statistically insignificant improvement in survival among patients receiving preoperative radiotherapy. Nevertheless, 2 subpopulations demonstrated significant improvement in survival following preoperative radiation, that is patients with high stage (P3 and P4) and high grade tumors.

Pure Squamous Cell Carcinoma of the Bladder in Western Countries

“…A difference in response to integrated preoperative radiation between patients with transitional and squamous cell carcinomas could be expected by the fact that pelvic recurrences are the leading cause of progression and mortality in SCC. On the other hand, evidence of a therapeutic superiority of this regimen among patients with squamous tumors was provided in a randomized study [30]. Similar observations were also reported later by Swanson et al [31]in T2 and T3 stage SCC of the bladder.…”

Neoadjuvant Radiotherapy Improves Survival in Patients With T2b/T3 Bladder Cancer: A Population-Based Analysis

“…28,29 The lack of stratification by stage is one of the attributable reasons that precluded an earlier meta-analysis from showing a survival benefit with NART. Studies with early-and advanced-stage BC [21][22][23][24][25] were included in this analysis, as were those that used low NART doses, 21,22 diluting the potential effect of improved local control found for aggressive disease with NART. This meta-analysis 11 also included patients with bilharzial BC.…”

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

“…Ce bénéfice apparaissait plutôt pour les patients atteints de TVIM classées pT3a-b, mais la tolérance médiocre à l'irradiation semblait limitante [10,35]. Six études randomisées ont également évalué l'apport de la radiothérapie préopératoire (32-54 Gy) et ne retrouvaient pas de bénéfice significatif en termes de SG et de SSR [36][37][38][39][40][41]. Dans une population égyptienne avec un contexte de bilharziose et une histologie atypique, les résultats étaient similaires [40].…”

“…Six études randomisées ont également évalué l'apport de la radiothérapie préopératoire (32-54 Gy) et ne retrouvaient pas de bénéfice significatif en termes de SG et de SSR [36][37][38][39][40][41]. Dans une population égyptienne avec un contexte de bilharziose et une histologie atypique, les résultats étaient similaires [40]. Plus récemment, une méta-analyse incluant ces essais randomisés ne retrouvait aucun bénéfice de survie en faveur de la radiothérapie préopératoire [42].…”