A Cochrane review [Abstract] 1 included 3 studies with a total of 439 subjects. Preoperative radiotherapy followed by radical cystectomy (surgery) was superior in terms of overall survival compared to radical radiotherapy with salvage cystectomy (radical radiotherapy) at 3 years, OR 2.11, 95% CI 1.10 to 4.07) and at 5 years, OR 2.40, 95% CI 1.35 to 4.29) for patients that actually received the protocol treatment. On an intention-to-treat analysis for disease-free survival, the results were significantly in favour or surgery at 3 years (OR 1.96, 95% CI 1.06 to 3.65) but not at 5 years. The trials evaluated in the analysis were not recent (1977, 1982, and 1991), and major advances have been made since these trials in both surgery (with respect to neobladder construction) and radiotherapy and include areas such as CT planning, higher dose delivery, conformal radiotherapy and supportive care.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals). Included studies are partly outdated.
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