Postoperative Radiotherapy in Bladder Cancer Patients: 5-Year Institutional Experience of National Cancer Institute, Cairo University

Abstract

Purpose: Adjuvant radiation therapy could reduce loco regional failure, but currently has no defined role because of previously reported morbidity. NCI-Cairo routine work is to give adjuvant PORT for locally advanced bladder carcinoma patients. The aim of this work is to re-evaluate this protocol regarding its effect on prognosis and complications. Patients and Method: A retrospective study included 208 patients with pathologically proven bladder cancer who presented to the NCI, Cairo University from 2007-2011. All of them underwent RC with bilateral PLND followed by conventional post-operative radiotherapy in 2 - 6 weeks after surgery for 5000 cGy in 25 fractions, over 5 weeks using 2D technique. Analysis of data from their files was done for the treatment results, prognostic factors and complications. Results: Three years overall survival (OS) and disease free survival (DFS) for the whole group was ~60%, and 54% respectively in favour of the female gender, non-smokers, Squamous cell carcinoma patients, low grade tumours (grade 1 and 2) negative margins, N0, pT2b and early stage group showed the best prognoses. The 3 years metastases free survival (MFS) was ~71%. Only four factors showed a significant relation with the MFS which were the grade, LN status, T-stage and group staging. The local recurrence rate (LRC) at 2 years for the whole group was ~95% and 94% at 3 years. Only surgical margin status and extent of LN dissection had a significant impact on the LRC. Conclusions: Adjuvant radiotherapy shows sustained improvement in the loco regional control, and should be recommended for patients with locally advanced disease especially those with less than 10 dissected lymph nodes and those with positive margins.