Preoperative whole pelvis versus true pelvis irradiation and/or cystectomy for bladder cancer

Abstract

Between 1949 and 1974, 449 patients with bladder cancer were treated by radical cystectomy either alone (137 patients or following three preoperative radiation schemes (312 patients). True pelvis irradiation was delivered either 4000 cGy (rad) over 4 weeks in 119 patients, or 2000 cGy over 1 week in 86 patients; radical cystectomy was performed after periods averaging 6 weeks.and 2 days, respectively. Whole pelvic irradiation of 2000 cGy in 5 consecutive days was given to 107 patients who underwent cystectomy within 2 days later. Five-year survival rates for low-stage TIS-T 2 tumors of low histologic grade were 60–66% in the four treatment groups. The 5-year survival for high-stage tumors of high histologic grade, mainly in T 3 patients, was 9% in the cystectomy alone patients versus 24–32% in the preoperatively irradiated patients. The 5-year survival rates for high-stage low-grade and low-stage high-grade tumors, were 30% in the cystectomy alone group and 39–51% in the preoperative irradiation groups; the more favorable survival was noted in the whole pelvic irradiation group, which included 18% 5-year survivals for T 4 patients. Pelvic recurrence was reduced from 28% after cystectomy alone to 14–16% with true pelvis irradiation and 8% with whole pelvic irradiation. The reduced incidence of local recurrence, observed mainly in high stage or high grade tumors, was associated with tumor downstaging after irradiation. Extrapelvic metastases developed in 21–35% of the four treatment groups, underlining the inadequacy of the local radiation and surgical treatment in preventing subsequent distant spread.