الفهرس 
Introduction and aim of the work
Treatment verification and documentationOnly 14 pages are availabe for public view
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Abstract
Bladder cancer is the most oncologic problem in Egypt accounting for approximately 30.3% of all cancers and constituting about 40.6% of male cancers and 14.3% of female cancers. Traditionally, the standard line of treatment of invasive bladder cancer is radical cystectomy with urinary diversion or bladder replacement, with 5-year survival rates is generally less than 50%, but however, the psychological trauma of such radical cystoprostatectomy and the subsequent change of quality of life cannot be ignored. Moreover, many patients are poor surgical risks or refuse radical surgery. The results of radical radiotherapy as a single modality were more consistent with 5 years survival rates ranging from 20% to 40%. The present work represents a prospective clinical trial which designed to evaluate the effectiveness of combined external pelvic radiotherapy 44 Gy with bladder boost by external beam radiothery (20 Gy) & to compare this with combined external pelvic radiotherapy plus bladder boost by intraoperative electron radiotherapy (15-20 Gy) to the surgically exposed primary tumor site with bladder preservation in the management of patients with invasive bladder cancer then assessment of the complications. The present study included 32 patients with invasive bladder cancer T2, T3, T4a with negative lymph node involvement and no evidence of distant metastases. All patients were amenable for treatment by external beam radiotherapy phase I, 4400 cGy over 4.4 weeks. group I included 20 patients received boost radiotherapy to the bladder by external irradiation 2000 cGy /2 weeks and group II included 12 patients received bladder boost by intraoperative electron beam radiotherapy ranging (12-15 Mev). The median age of the studied group was 66.5 year and 62 year for group I and II respectively and the mean age was 64.3 years and 60.8 years in group I and two respectively. With male to female ratio 4:1 in group I and 3:1 in group II. Haematuria and dysuria were the most common presenting symptoms in both groups. In group I, one patient was of clinical stage T2, 6 patients were of clinical stage T3a, 9 patients were of clinical stage T3b and 4 patients were of clinical stage T4a. In group II one patient was of clinical stage T2, 4 patients were of clinical stage T3a, 13 patients were of clinical stage T3b and two patient were locally advanced T4a. Pure T.C.C. accounted for 70% and 75% for group I and group II respectively. TCC with squanous differentiation accounted for 20% and 5% for group I and II respectively. Only there were two patients (10%) with squamous cell carcinoma in group I and another four patients (20%) with Sq.c.c. Low grade tumors (GI and GII) represented 70% and 65% for group I and group II respectively while high grade tumors (GIII) accounted for 30% and 35% in group I and II. There was complete remission in 41.6% of cases in group II, versus 35% for group I while partial remission occur in 25% for group II versus 20% in group I. Two cases (16.7%) showed stabilization of disease and another two cases (16.7%) showed progressive disease for group II. Conclusions: Radical radiotherapy of muscle invasive bladder cancer is a known modality that give cure rate comparable to surgery with preserving the urinary bladder as a reservoir and maintaining the erectile power in male patients. To improve therapeutic ratio and to minimize complication rate (early and late) we are in need to give higher dose to a limited tumor volume. This can be achieved successfully if we use intraoperative radiotherapy with electron beam to boost the dose given by external beam irradiation. We recommend, to obtain better results with significant meaning, to use IORT treatment in each case with cancer bladder and also to use combined chemotherapy plus radiotherapy in randomized trials either unicenter or multicenter trials, using large number of patients if we aim to reach significant results in treatment of this important disease specially in developing countries with limited resources.