Adjuvant radiation therapy for locally advanced bladder cancer: A safe and promising emerging treatment option
Mené sur 153 patients atteints d'un carcinome urothélial de la vessie avec envahissement musculaire et à haut risque de récidive, cet essai multicentrique évalue la toxicité d'une radiothérapie après une cystectomie radicale et une chimiothérapie
Recurrence after radical cystectomy for patients with cT3-4N0-N+ disease is relatively high, with approximately one third developing local-regional failure as the initial site of relapse. [1-4] Chemotherapy given neoadjuvantly or adjuvantly can reduce rates of distant disease but has not been shown to reduce rates of local-regional relapse in this patient population [5, 6]. Adjuvant immunotherapy has been shown to improve disease-free survival in the Ambassador and CheckMate 274 trials but the impact of immunotherapy on local-regional control has not been reported [7, 8]. Local failures are rarely salvageable since the absence of the bladder combined with the proximity of small bowel to gross disease often precludes definitive dose salvage radiation. Morbidity and mortality from these recurrences is high, with only 1 out of 80 patients surviving more than 5 years in a large retrospective series[9].