Intestinal strictures complicating preoperative radiation therapy followed by radical cystectomy

Between January 1975 and January 1981, 100 patients with invasive bladder cancer were evaluated for therapy. Of these patients 51 were selected for treatment with preoperative radiation therapy followed by radical cystectomy. Of 36 patients who actually completed the integrated therapy 4 (11 per cent) had clinical intestinal strictures. Three strictures occurred more than 24 months and 1 less than 6 months postoperatively. Strictures involved the colon in 3 cases and the ileum in 1. An operation was required in 2 cases. We present these 4 cases, and discuss the pathophysiology and treatment of the radiation-injured intestine. Our experience suggests that preoperative radiation therapy in conjunction with radical cystectomy may be associated with the development of clinically significant bowel injury. This factor should be considered in the decision to combine preoperative radiation therapy with radical cystectomy in the treatment of bladder cancer.