Definitive and adjunctive external irradiation in bladder cancer without radical cystectomy

The retrospective study of 150 bladder tumor cases from I.P.O. (Madrid) that had received a total dose of 5,000 rads of radiotherapy and a minimum 3-year follow-up without subsequent radical surgery is presented. During 1974-1978 all those cases that complied with the minimum requirements were selected. Radiotherapy effectiveness has not been defined. In this series we report the natural evolution of patients with this final treatment. The fact that invasive bladder tumors will become downstaged following irradiation is well known. The percentage varies from 10-40 percent within a short period of time after radiotherapy. The time of response, the possibility of relapse, the prevention of new tumors and the delay in the evolution and disease progression have not been well established. Thus, we have tried to analyze in our series, the time period of tumor relapse in the superficial tumor group, the influence of radiotherapy, as well as the overall survival. In the advanced tumor group, we have examined the response of the tumor to radiotherapy, its lasting period, and survivals. In clinic, a high number of patients with invasive bladder tumor do not undergo total surgery because of the frequent high surgery risk, old age, patient refusal, or indecision by the surgeon. Sometimes the real aggressiveness of the tumors is not apparent initially, or, at diagnosis, the disease has advanced to a stage that precludes effective surgery. In view of the results of chemotherapy in advanced bladder tumors, definitive radiotherapy in older patients with frequent renal dysfunction can result in frequent control of hematuria as well as tumor regression.(ABSTRACT TRUNCATED AT 250 WORDS)