Local-regional failure for patients with ≥pT3 urothelial carcinoma after radical cystectomy is a significant clinical challenge. Prospective randomised trials have failed to show that chemotherapy reduces the risk of local-regional recurrences. Salvage treatment for local failures is difficult and often unsuccessful. There is promising evidence, particularly from a recent Egyptian National Cancer Institute trial, that radiation therapy plus chemotherapy can significantly reduce local recurrences compared with chemotherapy alone, and that this improvement in local-regional control may translate to meaningful improvements in disease-free and overall survival with acceptable toxicity. In light of the high rates of local failure following cystectomy for locally advanced disease and the progress that has been made in identifying patients at high risk of failure and the patterns of failure in the pelvis, the National Comprehensive Cancer Network guidelines were revised to include postoperative radiotherapy as an option to consider for patients with ≥pT3 disease. Here we review the problem of local-regional failure after cystectomy, identify patients who would probably benefit from adjuvant radiotherapy, review the patterns of pelvic failure after cystectomy, discuss technical details of radiation treatment and review the modern literature on this topic. Adjuvant radiotherapy should be considered as a treatment option for patients with locally advanced disease, especially those with positive margins or squamous cell carcinoma.

根治性膀胱切除术后≥pT3 尿路上皮癌患者的局部区域失败是一项重大的临床挑战。前瞻性随机试验未能表明化疗可降低局部区域复发的风险。对局部故障的补救处理很困难，而且常常不成功。有希望的证据，特别是来自埃及国家癌症研究所最近的一项试验，放疗联合化疗与单独化疗相比可以显着减少局部复发，并且局部区域控制的这种改善可能转化为无病和整体的有意义的改善以可接受的毒性存活。鉴于局部晚期疾病膀胱切除术后局部失败率高，以及在识别高失败风险患者和骨盆失败模式方面取得的进展，国家综合癌症网络指南修订为包括术后放疗作为≥pT3 疾病患者的一种选择。在这里，我们回顾了膀胱切除术后局部失败的问题，确定可能受益于辅助放疗的患者，回顾膀胱切除术后盆腔衰竭的模式，讨论放射治疗的技术细节，并回顾了关于该主题的现代文献。对于局部晚期疾病患者，尤其是切缘阳性或鳞状细胞癌患者，应考虑将辅助放疗作为一种治疗选择。