title: Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study.
abstract: OBJECTIVE
  Radical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We evaluate 3-year LRR-free (LRRFS), metastasis-free (MFS) and overall survivals (OS) after adjuvant radiotherapy (RT) for pathological high-risk MIBC.
  
  
  METHODS
  We retrospectively reviewed data from patients in 3 institutions. Inclusion criteria were MIBC, histologically-proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. Outcomes were evaluated by Kaplan-Meier method. Acute toxicities were recorded according to CTCAE V4.0 scale.
  
  
  RESULTS
  Between 2000 and 2013, 57 patients [median age 66.3 years (45-84)] were included. Post-operative pathological staging was ≤pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% pN0, 26% pN1 and 42% pN2. Median number of lymph-nodes retrieved was 10 (2-33). Forty-eight patients (84%) received platin-based chemotherapy. For RT, clinical target volume 1 (CTV 1) encompassed pelvic lymph nodes for all patients. CTV 1 also included cystectomy bed for 37 patients (65%). CTV 1 median dose was 45 Gy (4-50). A boost of 16 Gy (5-22), corresponding to CTV 2, was administered for 30 patients, depending on pathological features. One third of patients received intensity-modulated RT. With median follow-up of 40.4 months, 8 patients (14%) had LRR. Three-year LRRFS, MFS and OS were 45% (95%CI 30-60), 37% (95%CI 24-51) and 49% (95%CI 33-63), respectively. Five (9%) patients had acute grade ≥3 toxicities (gastro-intestinal, genito-urinary and biological parameters). One patient died with intestinal fistula in a septic context.
  
  
  CONCLUSIONS
  Because of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. Adjuvant RT is feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.
authors.affiliation: Department of Radiotherapy, Institut Bergonié, Bordeaux,France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Orré
authors.affiliation: Department of Radiotherapy, Groupe Oncorad Garonne, Clinique Pasteur, Toulouse, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Latorzeff
authors.affiliation: Department of Medical Oncology, Centre Léon-Bérard, Lyon, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Fléchon
authors.affiliation: Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
authors.forename: Guilhem
authors.initials: G
authors.lastname: Roubaud
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Brouste
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
authors.affiliation: Department of Urology, Clinique Saint-Augustin, Bordeaux, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Piéchaud
authors.affiliation: Department of Radiotherapy, Institut Bergonié, Bordeaux,France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Richaud
authors.affiliation: Department of Radiotherapy, CHU de Lyon-Sud, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chapet
authors.affiliation: Department of Radiotherapy, Institut Bergonié, Bordeaux,France.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0002-7301-0870
authors.initials: P
authors.lastname: Sargos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology*; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*