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

Abstract

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. For decades left, both pre-and post-operative radiotherapy in bladder cancer had negative image for genitourinary oncologists. 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. It was clear from their results that both immediate postoperative complications and late serious gasterointestinal (GIT) sequalae were similar in both groups and of minimal amplitude. Late bowel complications were reported to be 4.5% in the post-operative setting and 2% in the pre-operative setting this was nearly similar to the percentages reported previously by Zaghloul et al. [3] who reported 4% and 5% grade 3+4 late bowel toxicity in conventional and hyper fractionated postoperative radiotherapy groups. In another retrospective study, a total of 12% of the patients who received PORT experienced chronic intestinal complications of different grades compared with 8% in the cystectomy alone group. There were four patients in each group (5.8% and 3.3%, respectively) that needed surgery for intestinal late complications [4] . On the other hand, much higher late GIT complications were reported by Reseinger et al. [5] . They experienced 37% late GIT complications with 22