| Objectives: To explore the efficiency of adjuvant radiotherapy followed by radical cystectomy versus radical radiotherapy with salvage cystectomy in patients with muscle invasive bladder cancer through comparing the overall survival after the treatments.Materials and Methods : The Cochrane Controlled Trials Register,MEDLINE,EMBASE, CBMdisc,VIP Chinese Science and Technology Journals Database,Tsinghua Tongfang database were searched. Three articles in which randomised trials comparing radical cystectomy versus salvage cystectomy were eligible for assessment. Data were extracted from the text of the article. then relevant data were extracted from methodological eligible studies for meta-analysis. RevMan 4.2 software package was used for meta-analysis .Results:Three randomised trials comparing adjuvant radiotherapy followed by radical cystectomy versus radical radiotherapy with salvage cystectomy in patients with muscle invasive bladder cancer were eligible for assessment.These trials represented a total of 439 patients,221 randomised to adjuvant radiotherapy followed by radical cystectomy and 218 to radical radiotherapy with salvage cystectomy. The mean overall survival (intention-to-treat analysis) at 3 and 5 years were 45% and 36% for radical cystectomy, and 28% and 20% for salvage cystectomy, respectively. Peto odds ratio(95% confidence interval) analysis consistently favoured radical cystectomy in terms of overall survival. The results were significantly in favour of radical cystectomy at 3 years(OR =1.91,95%CI 1.30 to 2.82) and at 5 years(OR =1.85 95%CI 1.22 to 2.82).Conclusion :The analysis of this review suggests that there is an overall survival benefit with adjuvant radiotherapy followed by radical cystectomy compared to radical radiotherapy with salvage cystectomy in patients with muscle invasive bladder cancer. |
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