Reappraisal of the Role of Radical Radiotherapy and Salvage Cystectomy in the Treatment of Invasive (T2/T3) Bladder Cancer

Abstract

One hundred and eighty-two patients with invasive (T2/T3) bladder cancer were treated by radical radiotherapy at the London Hospital between 1974 and December 1985. Cystectomy was reserved for patients whose tumours either did not respond completely to radiation or recurred later, provided they were fit for surgery and had not developed distant metastases. The overall corrected 5-year survival rate was 40%; 75 patients responded to radiation and did not relapse during the period of follow-up; 20 patients had an initial response to radiation but subsequently relapsed, with a 5-year survival rate following relapse of 20%. Of these, 11 patients had a cystectomy with a 5-year survival following relapse of 36%, whereas all 9 patients who did not have a cystectomy died within 3 years; 87 patients who did not respond to radiation had a 5-year survival rate of 18%. Of these, 22 patients underwent salvage cystectomy with a 5-year survival of 47%, whereas the 65 patients who did not have a cystectomy had a 5-year survival of 3%. These results justify a policy of radical radiotherapy and salvage cystectomy rather than elective cystectomy in the treatment of invasive bladder cancer.

An evaluation of gemcitabines differential radiosensitising effect in related bladder cancer cell lines

“…The overall 5-year survival rates are 24 -29% (Blandy et al, 1980;Fossa et al, 1993), a figure lower than in some surgical series (Skinner et al, 1991). However, in some reported series, radiotherapy has overall 5-year survival figures similar to radical cystectomy (Jenkins et al, 1988). Although both treatments have comparable morbidity and mortality, there is one fundamental difference: with radiotherapy, the patient retains a functioning natural bladder and males will usually retain erectile function.…”

The role of radiotherapy in urinary bladder cancer: current status

“…An English retrospective study showed 40% five-year survival with 41% of local control in 182 patients with T2 and T3 urinary bladder cancer treated with RT (26).…”

Bladder preservation in the treatment of muscle-invasive bladder cancer

“…Bladder preservation with monotherapy has yielded inferior rates of local control. The 5-year overall survival in radiation therapy series ranges from approximately 25% to 45% [9][10][11][12][13]. Nearly half of these patients require radical cystectomy or further treatment for either residual disease or local relapse in the bladder.…”