Results of radiation therapy for bladder tumors

Of 52 patients with high stage (T2-4), or high grade and low stage (T1) bladder tumor during the 7 year-period from 1975 to 1981, 23 patients were treated with preoperative irradiation and total cystectomy, 4 with preoperative irradiation and partial cystectomy, and 25 with curative irradiation therapy. The dose of the irradiation was 2000 or 4000 rads (whole pelvis) in the preoperative irradiation group, and 5000-6000 rads (4000 rads to whole pelvis followed by 1000-2000 rads to bladder region) in the curative irradiation group. The results were as follows: 1) The three and five year survival rates of patients with T1, T2 and T3 tumor treated with preoperative radiation and surgery were 100%-100%, 80-43% and 45%-23%, whereas those of patients treated with curative irradiation were 73%-62%, 26%-0% and 0%-0%, respectively. 2) Downstaging of tumor was observed in 45% of overall patients. According to histologic growth pattern of tumors, the rate of downstaging was markedly high, (100%-7/7) in non-papillary microinvasive carcinoma compared to superficial papillary carcinoma (50%-4/8) and invasive carcinoma (31%-10/32). 3) The three and five year survival rates of patients with invasive carcinoma (T2-4) were 100% and 57%, respectively, in 6 patients who achieved downstaging of tumor, whereas they were 50% and 11%, respectively, in 16 patients who didn't achieve tumor downstaging by preoperative irradiation. 4) The incidence of local (pelvic) recurrence in the preopeartive irradiation group was low (7%-2/27) compared to the curative irradiation group (32%-8/25). However, the incidence of distant metastasis was high (>20%) in both groups. 58% of distant metastases occurred within one year and 92% within 3 years. (author)