A Potential Role for Adjuvant Chemotherapy and Radiotherapy for Patients With High-Risk Bladder Cancer Treated With Cystectomy in the United States

In the this issue, Zaghloul and colleagues¹ report improved locoregional recurrence–free survival (LRFS) of patients with pT3/T4 and node-positive bladder cancer treated with cystectomy, followed by adjuvant chemotherapy and radiotherapy (ACRT), compared with chemotherapy alone. This trial constitutes the first randomized study to date to support the use of adjuvant ACRT in patients with urothelial carcinoma (UC) of the bladder. This work builds on a prior study by Zaghloul et al² demonstrating improved disease-free survival and local control with adjuvant radiotherapy (ART) for patients with pathologic high-risk features. Although the 1992 study² established the standard use of ART in Egypt, a preponderance of patients with squamous cell carcinoma and a 36% incidence of late radiation enteritis discouraged adoption of this regimen in other nations.