Setting the Dilemma of Adjuvant Radiotherapy in Patients with Locally Advanced Bladder TCC

Objectives: Muscle Invasive Bladder Cancer (MIBC) remains a lethal disease, despite aggressive local and systemic therapies with Radical Cystectomy (RC) ± Neo-Adjuvant Chemotherapy (NACT). The 5-year Overall Survival (OS) in advanced cases was around 32%. So novel treatment modalities are required. Our aim is to study the impact of adding Postoperative Radiotherapy (PORT) to standard chemotherapy on local control, survival outcomes and toxicity pattern. Methods: In this study, 123 MIBC patients’ medical records were reviewed and classified into 3 groups according to their treatment modalities; A (RC Chemotherapy), B (RC Radiotherapy), and C (RC Chemo and Radiotherapy). Results: Over a median follow-up of 18.5 months, the 5-year disease free survival (DFS) of group B was significantly higher (80.4%) compared to groups A and C (41.1% & 29.9% respectively; p= 0.0073). Additionally, the 5-year OS was higher in group B (77%) compared to groups A (33.9%) and C (28.5%), (p=0.041). However, the median Local Recurrence Free Survival (LRFS) for the whole group was 69.03 months (95% CI: 69.03 to 69.03), with no significant difference among the 3 groups (p=0.067). Conclusion: Our results suggest that the addition of adjuvant radiotherapy improved the Disease-Free Survival (DFS) and OS in MIBC patients. Although NACT remains the standard of care, incorporation of PORT should be considered in the future management of these cases.