Bladder carcinoma. Experience with radical and preoperative radiotherapy in 421 patients

Abstract

Four hundred twenty‐one patients with bladder carcinoma were treated with radical intent between 1968 and 1981: 356 were treated with irradiation alone with megavoltage tumor doses of 60‐66 Gy delivered over a period of 6 to 7 weeks. Actuarial 5‐ and 10‐year survival was 66% and 58% for Stage A (58 patients), 42% and 35% for Stage B1 (62 patients), 35% and 28% for Stage B2 (120 patients), and 23% and 19% for Stage C (75 patients), respectively. Five‐year survival after salvage cystectomy (47 patients) was 51% from the time of surgery, with 4 operative mortalities and a major complication rate of 30%. Sixty‐five patients were entered into an integrated preradical cystectomy irradiation program. Fifty‐three patients in stages B2–C–D1 received high‐dose preoperative radiotherapy (40‐50 Gy) before a planned, delayed radical cystectomy. The actuarial 5‐year survival was 66% for 65 patients, and 64% for the 53 patients in the high‐dose precystectomy program; major complications were encountered in 34% and there were 2 mortalities. Five‐year actuarial survival for Stage B2–C was 30% but fell to 24% when patients with salvage cystectomy were excluded. Distant metastasis was found in 30% of patients in Stage B2–C–D1, and also in the high‐dose precystectomy program patients. Two‐thirds of patients with distant metastasis in the radiation alone group were never considered for salvage cystectomy as they had distant metastasis alone, persistent disease with metastasis within 6 months after initiation of irradiation, or local recurrence and distant metastasis simultaneously. Early local recurrence may be salvaged in 50% to 60% of patients without a significant increase in mortality or major complications. Accordingly, a program of radical irradiation with salvage cystectomy may avoid loss of the bladder in 45% of patients in Stage B2–C–D1 without compromising overall survival. Copyright © 1985 American Cancer Society