Planned preoperative radiation therapy in muscle invasive bladder cancer; results of a meta-analysis.
BACKGROUND
The role of pre-operative radiation therapy in the treatment of muscle invasive bladder cancer is unclear. The objective of this report is to present a meta-analysis of the published clinical trial data on this topic to determine whether pre-operative radiation improves survival in patients with this disease.


METHODS
Data from 5 randomized trial were pooled using the meta-analytic techniques previously described by Peto et al. Three and five year survival were compared between patients receiving pre-operative radiation therapy followed by cystectomy versus patients treated with cystectomy alone.


RESULTS
A summary odds ratio was calculated following a statistical analysis showing a lack of heterogeneity among the included studies in terms of their estimate of effect. The calculated Peto odds ratio was 0.71 favoring the use of preoperative radiation (95% CI 0.48-1.06). Due to possible biases in this original analysis due to study design deficiencies, a sensitivity analysis showed a "corrected" odds ratio of 0.94 with a 95% confidence interval of 0.57- 1.55, a non-statistically significant result.


CONCLUSIONS
The available clinical trial data do not support a role for routine use of pre-operative radiation therapy in the treatment of muscle invasive bladder cancer. Additional well designed trials are needed to address this issue.
Meta-Analysis Research Group, Dunwoody, GA 30338, USA.
M
M
Huncharek
J
J
Muscat
J F
JF
Geschwind
D015653:Cystectomy; D006801:Humans; D019042:Muscle Neoplasms / Q000556:secondary; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D011300:Preoperative Care; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*