Radiation management of squamous cell carcinoma of the bladder

This is a retrospective analysis of 52 patients with squamous cell carcinoma of the bladder treated by irradiation between 1958 and 1978. There were 28 males and 24 females with hematuria being the leading symptom. At the time of initial presentation, 2 patients were evaluated to be stage B1, 34 patients to be B2C and 16 patients stage D. Nineteen patients were treated by preoperative irradiation (50 Gy/5 weeks) plus cystectomy and 33 patients were treated by irradiation alone (60-65 Gy/6-6 1/2 weeks). From our study, it appears that in stage B2C , irradiation plus cystectomy offered a better disease-free survival (40%) than irradiation alone (16%). Local failures occurred less frequently in the group treated by preoperative irradiation and surgery than those treated by irradiation alone. However, the majority of failures occurring in the preoperative group were distant failures. Factors determining the success and failures appear to include: stage of the disease, type of treatment, tumor size, degree of tumor necrosis, depth of muscle involvement, and tumor grade. It is suggested that the treatment of choice for this disease be a combined approach--preoperative irradiation and cystectomy whenever possible to minimize the loco-regional failures. Chemotherapeutic agents or radiation sensitizers combined with radiation should be further studied to minimize the distant metastases and loco-regional failures in most advanced inoperable squamous cell carcinoma of the bladder.