Adjuvant "sandwich" radiation therapy for bladder cancer

[Perioperative strategies in patients with muscle invasive bladder cancer]

Radical cystectomy with bilateral pelvic lymph node dissection is the standard of care for patients with muscle-invasive bladder cancer, with 5-year survival rates not exceeding 60%. Consequently a multidisciplinary approach including perioperative chemotherapy and/or radiation therapy is required to improve these results. Data from clinical trials and meta-analyses with neoadjuvant chemotherapy have shown a significant benefit in overall survival, with a 5% absolute benefit at five years, provided cisplatin-based combination chemotherapy is used. Reported trials do not support the routine use of adjuvant chemotherapy. The current role of radiation therapy is limited to highly selected cases with a combination of external radiotherapy, partial cystectomy and interstitial brachytherapy.

Radiation therapy for transitional cell bladder carcinoma. A ten-year experience

From 1969 to 1979, 185 patients with transitional cell bladder carcinoma were curatively irradiated; 147 were treated with radiation alone (RT) and 38 received a combined radiation + surgery (RT + S). At presentation, 40 percent of the patients had obstructive uropathy which yielded a much lower five-year survival (18%) than when it was absent (50%). The overall five-year disease-free survival was 30 percent and 53 percent for patients treated with radical RT and RT + S, respectively. Among patients subjected to preoperative irradiation, downstaging was seen in 40 percent of postsurgical specimens, with 27 percent of the specimens showing no evidence of tumor; these patients had excellent survival. Severe complications were seen in 3 percent, 10 percent, and 27 percent of patients in the radical RT, RT + S, and radical RT + salvage cystectomy groups. Survival results, pelvic controls, and patterns of failure are presented.

Combined pre- and postoperative adjuvant radiotherapy for bladder cancer

Thirty-nine patients with invasive bladder cancer were treated using a new approach to adjuvant radiation therapy. All patients had histologic evidence of bladder muscle invasion on biopsy and were considered suitable for surgical resection. Low-dose preoperative radiation (500 rad) was delivered either on the day of or the day before cystectomy. In most instances, a radical cystectomy was performed and patients were then stratified according to pathologic stagings. Those patients with pathologically good prognostic indicators, Stage B1 low grade (I or II) disease, were followed up with no further treatment. Patients at high risk for local recurrence and pelvic lymph node involvement, Stages B1 high grade (III or IV), B2, and C, were given aggressive postoperative radiation (4,500 rad in five weeks). Patients with advanced disease, Stage D2, were given palliative therapy. All patients received the dose of preoperative radiation as planned. Preliminary results indicate that combined pre- and postoperative radiation in bladder cancer gives excellent local control of disease. A significant potential for improved long-term survival of patients has been observed.