The rationale for post-operative radiation in localized bladder cancer.
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Authors
Baumann, BSargos, P
Eapen, L
Efstathiou, J
Choudhury, Ananya
Bahl, A
Murthy, V
Ballas, L
Fonteyne, V
Richaud, P
Zaghloul, M
Christodouleas, J
Affiliation
Hospital of the University of Pennsylvania, Philadelphia, PA, USAIssue Date
2017-01-27
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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.Citation
The rationale for post-operative radiation in localized bladder cancer. 2017, 3(1):19-30 Bladder CancerJournal
Bladder CancerDOI
10.3233/BLC-160081PubMed ID
28149931Type
ArticleLanguage
enISSN
2352-3727ae974a485f413a2113503eed53cd6c53
10.3233/BLC-160081
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