PLANNED PREOPERATIVE RADIATION-THERAPY IN MUSCLE INVASIVE BLADDER-CANCER - RESULTS OF A METAANALYSIS

Background. The role of pre-operative radiation therapy in the treatme nt of muscle invasive bladder cancer is unlcear: The objective of this report is to present a meta-analysis of the published clinical trial data on this topic to determine whether pre-operative radiation improv es survival in patients with this disease. Methods. Data from 5 random ized trials were pooled using the meta-analytic techniques previously described by Peto et al. Three and five year survival were compared be tween patients receiving pre-operative radiation therapy followed by c ystectomy versus patients treated with cystectomy alone. Results. A su mmary odds ratio was calculated following a statistical analysis showi ng a lack of heterogeneity among the inlcuded studies in terms of thei r estimate of effect. The calculated Peto odds ratio was 0.71 favoring the use of pre-operative radiation (95% CI 0.48-1.06). Due to possibl e biases in this original analysis due to study design deficiencies, a sensitivity analysis showed a ''corrected'' odds ratio of 0.94 with a 95% confidence interval of 0.57- 1.55 a non-statistically significant result. Conclusion The available clinical trial data do not support a role for routine use of pre;operative radiation therapy in the treatm ent of muscle invasive bladder cancer Additional well designed trials are needed to address this issue.