A prospective randomized trial for postoperative vs. preoperative adjuvant radiotherapy for muscle-invasive XXXX .

@entity1 @entity957 @entity150 @entity189
PURPOSE: Although radical cystectomy is considered to be the primary treatment for muscle-invasive @entity150 , it is associated with unfavorable outcome. Local recurrence is still a major problem. Survival rates as well as quality of live are far from being satisfactory. Postoperative radiotherapy is considered the standard adjuvant treatment in the NCI-Egypt. This is a prospective randomized study conducted to compare preoperative with postoperative radiotherapy as regard the survival and complication rates. @entity1 AND METHODS: In the period from May, 2004 to June 2007, 100 eligible @entity1 were included into the study, 50 @entity1 in each treatment arm. Pelvic irradiation was identical in both groups aiming at 50 Gy/25 Fs/5 wk. Radical cystectomy was the standard surgery. Locoregional control, survival rates, and complications rates were compared in both arms. RESULTS: @entity1 had a median follow-up period of 32 months (range 0-69 months). @entity1 had an average age of 54.8    9.5 years with a male/female ratio 3:1. In the present study, transitional cell @entity189 constitutes (51%), @entity957 was reported in 46% of cases. Grades II and III pathology were 81% and 17%, respectively. Pathological stage P2b was encountered in 39.5% of the @entity1 followed by P3b (33.3%) and P3a (14.6%). For the preoperative group, the 3-year overall survival, disease-free survival, locoregional control, and metastases-free survival rates were 53.4%, 47.4%, 89.3%, and 61.5%, respectively. The corresponding figures for the postoperative group were 51.8%, 34.1%, 80.6%, and 55.7% for the postoperative group. None of the @entity1 had serious radiation reactions. CONCLUSION: In our study, preoperative radiotherapy was almost equivalent to postoperative radiation therapy as regard OS, DFS, as well as complication rates. Given the recent physical developments in radiation therapy techniques and the biological rationale for treating the pelvis after cystectomy, adjuvant radiotherapy should be re-evaluated world wide. Preoperative radiotherapy may re-emerge as a useful tool for adjuvant treatment.
