title: Contemporary cystectomy versus preoperative radiation plus cystectomy for bladder cancer.
abstract: The role of preoperative radiation therapy (RT) as an adjunct to radical cystectomy (C) was studied by reviewing 58 consecutive patients requiring bladder removal during 1980-1982 for transitional cell carcinoma (TCC). Thirty-six patients underwent RT + C; 22 had C alone. The sole reason for choosing between RT + C versus C was physician prejudice favoring one form of therapy over another. Pretreatment clinical staging was similar in both groups, slightly favoring the RT + C group with only 25 percent versus 36 percent of C patients with clinical stage exceeding B1. Pathologic stage distribution similarly favored the RT + C group slightly with only 56 percent versus 68 percent of C patients having lesions with P-stage greater than B1. Thirty-three percent of patients in the RT + C group had papillary lesions in contrast to only 27 percent in the C alone group. There was only one postoperative death in each group. Three-year minimal follow-up was available in all surviving patients. One-, two-, and three-year survival free of disease was 94 percent, 80 percent, and 70 percent, respectively, in the group treated by C alone. Similar figures for the RT + C group were 86 percent, 76 percent, and 60 percent, respectively. Projected five-year survival rates for both groups regardless of preoperative RT was over 60 percent. All but one failure in the RT + C group had 4,000 rad or more preoperative radiation. This contemporary study shows no advantage of preoperative radiation in patients requiring cystectomy for transitional cell carcinoma of the bladder.
authors.affiliation: Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: S A
authors.initials: SA
authors.lastname: Kaplan
authors.forename: I S
authors.initials: IS
authors.lastname: Sawczuk
authors.forename: K
authors.initials: K
authors.lastname: O'Toole
authors.forename: C A
authors.initials: CA
authors.lastname: Olsson
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*