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Whole Pelvis versus Bladder Only Radiotherapy in Trimodality Therapy for Negative Lymph Node Muscle Invasive Bladder Cancer


Aya Mahmoud Ebraheem
Mohamed Soliman Gaber
Asmaa Abdelghany Abdellatef
Rafaat Abdelaal Bakheet

Abstract

Background: Trimodality therapy has been recommended as a valid treatment option for well-selected patients of muscle invasive  bladder cancer (MIBC). The benefit of elective nodal irradiation during bladder radiotherapy (RT) remains a controversial topic.
Objectives: Our study comparing bladder only (BO) versus whole pelvis (WP) radiotherapy, concurrent with cisplatin to evaluate BO  radiotherapy outcome and toxicity.
Patients and methods: A randomized prospective study comparing BO versus WP radiotherapy using 3D conformal radiotherapy  concurrent with cisplatin followed by 4 cycles gemcitabine/cisplatin in nonmetastatic negative lymph node MIBC.
Results: Our cohort included 28 and 30 patients in BO and WP group, respectively. No statistically significant difference (P =0.59) was  detected between 2 groups as regard disease free survival (DFS)rate at 3 years, which was 81% and 85 % in BO and WP group,  respectively. At 3 years the reported bladder cancer specific survival and overall survival(OS) rate in BO group was 83% and 75 %,  respectively while for WP group the results were 80 % and 73%, respectively with no statistically significant difference between the 2  groups. Regarding RT toxicity, acute small bowel (P=0.03) and acute rectal toxicity (P=0.007) showed statistically significant difference  favouring BO radiotherapy while acute genitourinary toxicity (P=0.91), late genitourinary (P =0.33) and late GIT toxicity (P=0.4) showed no  statistically significant difference between the 2 groups.
Conclusion: BO radiotherapy concurrent with chemotherapy is an effective treatment option in patients with lymph nodenegative MIBC  with comparable oncologic outcomes and less RT toxicity when compared with WP radiotherapy. 


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eISSN: 2090-7125
print ISSN: 1687-2002