title: A prospective randomized trial for postoperative vs. preoperative adjuvant radiotherapy for muscle-invasive bladder cancer.
abstract: OBJECTIVE
  Although radical cystectomy is considered to be the primary treatment for muscle-invasive bladder cancer, it is associated with unfavorable outcome. Local recurrence is still a major problem. Survival rates as well as quality of live are far from being satisfactory. Postoperative radiotherapy is considered the standard adjuvant treatment in the NCI-Egypt. This is a prospective randomized study conducted to compare preoperative with postoperative radiotherapy as regard the survival and complication rates.
  
  
  METHODS
  In the period from May, 2004 to June 2007, 100 eligible patients were included into the study, 50 patients in each treatment arm. Pelvic irradiation was identical in both groups aiming at 50 Gy/25 Fs/5 wk. Radical cystectomy was the standard surgery. Locoregional control, survival rates, and complications rates were compared in both arms.
  
  
  RESULTS
  Patients had a median follow-up period of 32 months (range 0-69 months). Patients had an average age of 54.8 ± 9.5 years with a male/female ratio 3:1. In the present study, transitional cell carcinoma constitutes (51%), while squamous cell carcinoma was reported in 46% of cases. Grades II and III pathology were 81% and 17%, respectively. Pathological stage P2b was encountered in 39.5% of the patients followed by P3b (33.3%) and P3a (14.6%). For the preoperative group, the 3-year overall survival, disease-free survival, locoregional control, and metastases-free survival rates were 53.4%, 47.4%, 89.3%, and 61.5%, respectively. The corresponding figures for the postoperative group were 51.8%, 34.1%, 80.6%, and 55.7% for the postoperative group. None of the patients had serious radiation reactions.
  
  
  CONCLUSIONS
  In our study, preoperative radiotherapy was almost equivalent to postoperative radiation therapy as regard OS, DFS, as well as complication rates. Given the recent physical developments in radiation therapy techniques and the biological rationale for treating the pelvis after cystectomy, adjuvant radiotherapy should be re-evaluated world wide. Preoperative radiotherapy may re-emerge as a useful tool for adjuvant treatment.
authors.affiliation: Department of Radiation, National Cancer Institute, Cairo University, Cairo, Egypt.
authors.forename: Hassan Abd
authors.initials: HA
authors.lastname: El-Monim
authors.forename: Manal M
authors.initials: MM
authors.lastname: El-Baradie
authors.forename: Alaa
authors.initials: A
authors.lastname: Younis
authors.forename: Yaser
authors.initials: Y
authors.lastname: Ragab
authors.forename: Ashraf
authors.initials: A
authors.lastname: Labib
authors.forename: Inas
authors.initials: I
authors.lastname: El-Attar
mesh_terms: D000368:Aged; D015653:Cystectomy; D004534:Egypt; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology / Q000528:radiation effects; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010538:Peritonitis / Q000209:etiology; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery