| Article Title: |
Summary of Preoperative irradiation and cystectomy for bladder cancer (by Joseph A. Smith, Jr, MD, Mostafa Batata, MD, Harry Grabstald, MD, Pramod C. Sogani, MD, Harry Herr, MD, and Willet F. Whitmore, Jr, MD) |
| Abstract: |
Objective: To evaluate the impact of various regimens of planned, integrated irradiation and surgery for bladder cancer on local recurrence rate and overall survival.Patients and Methods: Four consecutive groups of patients with bladder cancer were evaluated retrospectively. The first consisted of 137 patients undergoing radical cystectomy alone. The second group of 119 patients received 40 Gy of radiation treatment to the whole pelvis followed by radical cystectomy. Group 3 was composed of 86 patients receiving 20 Gy of irradiation to the true pelvis, followed by radical cystectomy within 1 week. Group 4 consisted of 101 patients receiving a planned dose of 20 Gy to the whole pelvis between 1971 and 1974, followed by cystectomy.Results: The surgical mortality rate was lowest in group 4, which probably reflects improvements in perioperative care rather than any impact of the radiation regimen. In addition, the pelvic recurrence rate was lower in all three of the groups in which radiation was used compared with those undergoing surgery alone. The fact that distant recurrence was the primary cause of treatment failure muted the effect of a lower pelvic recurrence rate on overall survival. Nonetheless, the best 5-year survival rate (39%) was achieved in group 4 patients.Conclusion; A program of integrated preoperative irradiation followed by radical cystectomy in patients with bladder cancer decreases the local pelvic recurrence rate. Because distant disease is the primary cause of treatment failure, this has only a modest salutary effect on overall survival.Copyright © 1997 by W.B. Saunders Company |
