Planned preoperative radiation therapy in muscle invasive bladder cancer; Results of a meta-analysis

Background. The role of pre-operative radiation therapy in the treatment of muscle invasive bladder cancer is unclear. 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 improves survival in patients with this disease. Methods. Data from 5 randomized trials were pooled using the meta-analytic techniques previously described by Peto et al. Three and five year survival were compared between patients receiving pre-operative radiation therapy followed by cystectomy versus patients treated with cystectomy alone. Results. A summary odds ratio was calculated following a statistical analysis showing a lack of heterogeneity among the included studies in terms of their 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 possible 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 treatment of muscle invasive bladder cancer. Additional well designed trials are needed to address this issue.