The Rationale for Post-Operative Radiation in Localized Bladder Cancer.
Local-regional recurrence for patients with ≥pT3 disease after radical cystectomy is a significant problem. Chemotherapy has not been shown to reduce the risk of local-regional recurrences in randomized prospective trials, and salvage therapies for local-regional failure are rarely successful. There is promising evidence, particularly from a recent Egyptian NCI trial, that radiation therapy plus chemotherapy can significantly reduce local recurrences compared to chemotherapy alone, and that this improvement in local-regional control may translate to meaningful improvements in disease-free and overall survival with acceptable toxicity. In light of the high rates of local failure following cystectomy for locally advanced disease and the progress that has been made in identifying patients at high risk of failure and the patterns of failure in the pelvis, the NCCN guidelines were revised in 2016 to include post-operative radiotherapy as an option to consider for patients with ≥pT3 disease. Despite advances in our understanding of the problem of local-regional failure after cystectomy and the potential role of adjuvant radiotherapy, the question of whether adjuvant radiotherapy should have a defined role for patients with locally advanced urothelial carcinoma has not yet been determined. The results of the NRG, European, Indian, and Egyptian trials on adjuvant radiotherapy are eagerly awaited. While none of these trials on their own may provide definitive conclusions, their aggregate outcomes will help clarify whether this treatment should have a role in the management of patients with locally advanced bladder cancer.
Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Washington University in Saint Louis, Saint Louis, MO, USA.
Brian C
BC
Baumann
Institut Bergonié , Bordeaux, France.
Paul
P
Sargos
University of Ottawa , Ottawa, Canada.
Libni J
LJ
Eapen
Massachusetts General Hospital , Boston, MA, USA.
Jason A
JA
Efstathiou
Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Ananya
A
Choudhury
University Hospitals Bristol NHS Foundation Trust , Bristol, UK.
Amit
A
Bahl
Tata Memorial Center , Mumbai, India.
Vedang
V
Murthy
University of Southern California , Los Angeles, CA, USA.
Leslie K
LK
Ballas
Ghent University Hospital , Ghent, Belgium.
Valérie
V
Fonteyne
Institut Bergonié , Bordeaux, France.
Pierre M
PM
Richaud
National Cancer Institute, Cairo University, Cairo, Egypt; Children's Cancer Hospital, Cairo, Egypt.
Mohamed S
MS
Zaghloul
Hospital of the University of Pennsylvania , Philadelphia, PA, USA.
John P
JP
Christodouleas
Adjuvant radiation; bladder cancer; radical cystectomy