RADIATION THERAPY AND SURGERY IN THE TREATMENT OF CARCINOMA OF THE BLADDER

UNIVERSITY OF MARYLAND EXPERIENCE

¹ BALTIMORE, MARYLAND

Twenty-seven patients with bladder cancer were subjected to preoperative supervoltage irradiation and total cystectomy. A study of this group has yielded the following conclusions:

1. The preoperative evaluation of the presence or absence of tumor is inaccurate if compared minutely with the operative specimen.

2. It is not uncommon for recurrences or new tumors to appear in the bladder long after apparently successful irradiation.

3. Preoperative irradiation can eradicate some bladder tumors and in other cases reduce the bulk and extent of the tumor, thus altering the stage. All patients who were subjected to laparotomy post irradiation had resectable tumors.

4. Postoperative complications occurred in numbers similar to those reported in series without prior radiotherapy. Fortyfour per cent of patients had complications and 22 per cent died of them. The commonest and most serious complication involved bowel or the uretero-enteric anastomosis. Complications were most frequent if the interval between irradiation and surgery exceeded 9 weeks or if the patients were of advanced age.

5. The combination of preoperative irradiation and total cystectomy is a feasible approach to the management of invasive bladder cancer, and would appear to offer a more favorable prognosis than either modality alone. It deserves greater use and a more complete investigation of its possibilities.

6. We are planning to employ this approach in a systematic manner, using preoperative irradiation in all cases of infiltrating cancer of the bladder which are easily palpable, whether limited to or beyond the bladder, provided no distant metastases are present.

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