الفهرس 
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Abstract
Summary and conclusion
Bladder cancer is the ninth most common cancer worldwide and is more common in developing countries. (Parkin DM, et al, CA Cancer J Clin, 2005)
In Egypt, bladder cancer incidence is much higher than reported in western countries, bladder cancer contributed 6.94% of all cancer in Egypt, and males are more affected than females. (Amal S. Ibrahim, et al, Journal of Cancer Epidemiology, 2014)
Radical cystectomy (RC) and pelvic lymphadenectomy with or without neoadjuvant chemotherapy still remains the gold standard treatment for muscle-invasive bladder cancer. ( Bolenz C, BJU International, 2010)
But Loco regional recurrence following radical cystectomy for patients with muscle invasive UBC is common, its accounts for approximately 75% of the failures of this treatment. (Ghoneim M.A, et al, J. Urol, 1997)
Postoperative radiotherapy led to marked reduction in the incidence of local recurrence and hence improved the disease-free survival in bladder cancer patients. However, post-operative radiotherapy did not affect the inscidence of distant metastasis. (Zaghloul M.S, et al,Int. J. Radiat. Oncol. Biol, 1992)
There has recently been growing interest in adjuvant radiotherapy for bladder cancer following cystectomy. (Abol-Enein, H., et al. 2005)
The aim of this work is to evaluate the benefits of PORT in stage II &III bladder cancer after radical cystectomy as regard OS, DFS &DFFS and also to evaluate toxicity profile of such treatment.
Patients and methods
This retrospective study included patients with pathologically proven bladder cancer who presented to the oncology department, Sohag University Hospital, from January 2011 till December 2015. All of them stage two &three underwent radical cystectomy followed by adjuvant external beam radiotherapy +/- chemotherapy. All of the patients, included in the analysis completed their course of radiation (5000 cGy in 25 fractions, over 5 weeks using 2D technique).
The patients were staged according to the American joint committee of cancer clinical staging system 2010, surgical procedures included radical cystectamy or anterior pelvic exenteration followed by post-operative radiotherapy to the urinary bladder bed and pelvic lymph nodes with curative intent.
Results
Sixty two patients were retrieved. Out of 62 eligible bladder cancer patients , 2 patients (3%) developed local recurrence ,while 8 patients (13%) developed distant metastasis ,4 of them (6% of total sample ) developed bone mets,3of them (5% of total sample) developed lung mets and only one (2% of total sample) developed liver mets .
The OS among all 62 patients was 64% at 3-year .The age had significant impact on OS (p-value 0.001), bilharzial infestion had asignificant impact on OS (p-value 0.01), and also pathological type had significant impact on OS (p-value 0.04).
The DFS among all 62 patients was 83% at 3 years.Only pathological types had significant impact on DFS (P-value 0.04).
The LRC among all 62 patients 83% at 3 years.Only pathological type had significant impact on LRC (P-value 0.04).
In our study, 48 patients of studied population developed acute and chronic toxicity (77%), 41 patients (66%) developed acute intestinal toxicity, 3 patients (5%) developed late intestinal toxicity, and 15 patients (24%) developed acute skin toxicity.
Conclusion
In our retrospective study, post-operative radiotherapy showed good OS, DFS,LRCand DFFS rates that were in agreement with some previous studies. Due to the small number of patients, the relatively short follow up periods and the statistical bias linked to retrospective design of clinical studies, further prospective studies with longer follow up periods are warranted to better evaluate such an effect better with using new radiotherapy modalities such as CRT and IMRT.