Role of Radiotherapy with or without Chemotherapy in Treatment of Cancer Urinary Bladder Surgically Excised: A Retrospective Study

Background: BC is the 10th most common cancer type worldwide. About 75% 
of BC is non muscle invasive (NMIBC). However, in MIBC, the standard 
therapeutic approach consists of neoadjuvant chemotherapy, radical cystectomy 
(RC), +/- adjuvant chemotherapy. Following RC, in patients with ≥pT3 disease,
loco regional recurrence is a significant problem. Adding RTH to CTH in this 
situation has demonstrated a significant reduction in the rate of loco regional 
failure.
Purpose of the study: In this retrospective study, we aim to investigate the 
outcome of treatment of MIBC by RC and post operative RTH +/- CTH.
Patients and methods: This is a retrospective study included patients treated in 
Sohag University by RC with urinary diversion and pelvic RTH+/- CTH from 
January 2016 through December 2020. 
Results: A cohort of 75 patients identified, Males constituted 91% of them. 
Two subgroups were identified, tcc and scc representing 69% and 28% 
respectively. Chemotherapy was documented in 61% of patients. Conventional 
2 D RTH technique was implemented in 31 (41%) patients and 3 D RTH 
technique in 44 (59%) patients. Local, nodal and, distant failures were identified 
in 9 (12%), 6 (8%) and 7 (9%) patients respectively. Owing to the small number 
of distinct types of failures and for more meaningful statistical results, all 
failures were allocated in one group. Only T stage was found significantly 
affecting the OS in the whole cohort (p=0.05) but not in either one of the two 
subgroups, TCC and SCC. Both coexistent hypertension and DM significantly 
reduced the PFS in the whole cohort (p = 0.007 and 0.003 respectively) and in 
the TCC subgroup only (p = 0.041 and 0.011 respectively). Adding CTH to 
RTH significantly improved the OS in the TCC subgroup (p = 0.05).
Conclusions: In treatment of MIBC by RC, RTH and CTH, advanced stage, 
lack of cisplatin based CTH, co existent hypertension and DM adversely affect 
treatment outcome and further observational studies warranted to elucidate the 
influence of these comorbidities on treatment outcome.