title: Radiation therapy before cystectomy in the management of patients with bladder cancer.
abstract: During the preceding two decades, 309 patients with bladder cancer were treated by irradiation before cystectomy at the Memorial Sloan-Kettering Cancer Center. A radical tumour dose averaging 6000 cGy (rad) in six weeks was given to 104 patients who underwent radical cystectomy +/- one year later for persistent or recurrent cancer. Pre-operative pelvic irradiation was planned in 205 patients who received either 4000 cGy in four weeks (119) or 2000 cGy in one week (86) and underwent radical cystectomy after +/- six weeks and two days, respectively. The determinate five-year survival rates (41-43%) were similar with the three irradiation regimes; mortality under five years was mainly due to cancer recurrence locally and/or distally. Incidence of recurrence with radiation-induced stage reduction (21%) was lower, especially within the pelvis, than with no stage reduction (51%). Treatment results with planned pre-operative irradiation, especially in high stage tumours, were more favourable with the shorter 2000 cGy regimen of high fractional doses than with the conventionally fractionated 4000 cGy regimen.
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery