title: Adjuvant "sandwich" radiation therapy for bladder cancer.
abstract: Preliminary results of a study using a new concept of adjuvant "sandwich" radiotherapy in bladder cancer are presented. In this approach low-dose preoperative irradiation (500 rads) is delivered prior to cystectomy, and then on the basis of histopathologic staging patients with superficial tumors (Stage A and B) are followed with no further treatment; patients with deeply invasive tumors (Stage B, Grade III or IV, B2 or C) are treated with high-dose postoperative irradiation (4,500 rads in five weeks); and patients with advanced or metastatic disease (Stage D) are treated palliatively. Eighteen patients were treated with this approach, and all patients have been followed for at least one year. Sixteen (89 per cent) are alive with no evidence of tumor. One patient died of distant metastasis, and 1 patient died of peritonitis without evidence of disease. Since recurrence is known to develop in 50 per cent of patients within the first year after treatment, the low rate of failure obtained using this approach of adjuvant "sandwich" radiotherapy with a minimum follow-up of one year appears to be promising. This approach ideally balances the risk versus benefit ratio of adjuvant therapy sparing patients with superficial tumors from unnecessary treatment while treating patients with more advanced disease aggressively.
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009366:Neoplasm Seeding; D011878:Radiotherapy / Q000379:methods; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy* / Q000601:surgery