Invasive bladder cancer. Should patients who respond to radiotherapy be treated by cystectomy?

A retrospective study was carried out on the long-term survival (5-12 years) of 160 patients with invasive transitional cell cancer of the bladder treated with irradiation between 1972 and 1980. Following 40 Gy irradiation of the lower abdomen, treatment consisted of cystectomy or continued irradiation of the bladder region only. A full urological examination of the bladder established whether a patient was a responder or non-responder. The patients were divided into four groups: 27 responders treated with cystectomy and diversion; 48 responders treated with continued radiotherapy up to 65 Gy; 24 non-responders treated with cystectomy and diversion; 42 non-responders treated with continued radiotherapy up to 65 Gy. Survival and complications of treatment were compared with regard to category and grade of the tumours and sex and age of the patients. It was concluded that the responders who underwent cystectomy after 40 Gy irradiation survived longer than those who received a full course of radiotherapy. The responders had a better survival rate than non-responders, regardless of further treatment. Salvage cystectomy was rarely carried out and proved to be an unsatisfactory alternative, with a high operative risk and short survival.