Treatment of advanced bladder cancer category T2, T3 and T4a

From 1983 to 1986 183 patients with transitiocellular carcinoma of the urinary bladder, category T2-T4a, entered a randomized study. The patients were allocated to receive either preoperative irradiation (40 Gy) followed by cystectomy or radical irradiation (60 Gy) followed by salvage cystectomy in case of residual tumor. The two randomization groups included 88 and 95 patients respectively. The treatment plan was followed by 66 patients (75%) in the planned cystectomy group and by 88 (92%) in the radical radiotherapy group of which 27 (28%) were treated with salvage cystectomy. The results showed a trend to a higher survival rate following the combined treatment with preoperative irradiation and cystectomy compared to radical irradiation followed by salvage cystectomy in case of residual tumor, but a statistical significant difference could not be demonstrated. The T-category, response to radiotherapy and frequency of lymph node metastases were found to be of prognostic importance. Although preoperative irradiation with planned cystectomy tends to give better, but not significantly better results, patients with advanced bladder cancer have an option to choose radical irradiation with the perspective of preserving the bladder function. (au)