Radical cystectomy (RC) associated with pelvic lymph node dissection (PLND) is the most common local therapy in the management of non-metastatic muscle invasive bladder cancer (MIBC). Loco-regional recurrence (LRR), however, remains a common and important therapeutic challenge associated with poor oncologic outcomes. We aimed to systematically review evidence regarding factors associated with LRR and to propose a framework for adjuvant radiotherapy (RT) in patients with MIBC.
We performed this systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We searched the PubMed database for articles related to MIBC and associated treatments, published between January 1980 and June 2015. Articles identified by searching references from candidate articles were also included. We retrieved 1383 publications from PubMed and 34 from other sources. After an initial screening, a review of titles and abstracts, and a final comprehensive full text analysis of papers assessed for eligibility, a final consensus on 32 studies was obtained.
LRR is associated with specific patient-, tumor-, center- or treatment-related variables. LRR varies widely, occurring in as many as 43% of the cases and is strongly related to survival outcomes. While perioperative treatment does not impact on LRR, pathological factors such as pT, pN, positive margins status, extent of PLND, number of lymph nodes removed and/or invaded are correlated with LRR. Patients with pT3-T4a and/or positive lymph-nodes and/or limited pelvic lymph-node dissection and/or positive surgical margins have been distributed in LRR risk groups with accuracy.
LRR patterns are well-known and for selected patients, adjuvant treatments could target this event. Intrinsic tumor subtype may guide future criteria to define a personalized treatment strategy. Prospective trials evaluating safety and efficacy of adjuvant RT are ongoing in several countries.
Cancer treatment reviews. 2018 Jul 21 [Epub]
Paul Sargos, Brian C Baumann, Libni Eapen, John Christodouleas, Amhit Bahl, Vedang Murthy, Jason Efstathiou, Valérie Fonteyne, Leslie Ballas, Mohamed Zaghloul, Guilhem Roubaud, Mathieu Orré, Stéphane Larré
Department of Radiation Oncology, Institut Bergonié, F-33076 Bordeaux Cedex, France. Electronic address: ., Department of Radiation Oncology, Washington University, St. Louis, Washington, MO 63110, United States., Department of Radiation Oncology, Ottawa Hospital, K1H 8L6 Ottawa, ON, Canada., Department of Radiation Oncology, Perelman Center for Advanced Medicine, 19104-6021 Philadelphia, PA, United States., Department of Radiation Oncology, University Hospitals Bristol, Bristol BS2 8HW, United Kingdom., Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012, India., Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States., Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium., Department of Radiation Oncology, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA 90033, United States., Children's Cancer Hospital Egypt, National Cancer Institute, Cairo University, Cairo, Egypt., Department of Medical Oncology, Institut Bergonié, F-33076 Bordeaux Cedex, France., Department of Radiation Oncology, Institut Bergonié, F-33076 Bordeaux Cedex, France., Department of Urology, Centre Hospitalier Universitaire de Reims, F-51092 Reims, France.