[Is the improvement of survival in advanced bladder cancer possible?]

A retrospective study included 41 cases of bladder cancer, with deep invasion of the muscles (C) or perivesicular cellular tissue (D), but without detectable metastases, treated curatively by total cystectomy. Comparison was made between a first group of 19 patients not treated by cellulolymphadenectomy and another group of 22 patients in whom curettage was performed to remove cells and nodes and who also received 2 concentrated radiations of 7-5 Gy of telecobalt to the bladder during the immediate pre-operative period. Only 10 patients in the latter group were given routine postoperative chemotherapy. Postoperative mortality was unaltered (10,5% in the first group and 9% in the second), but postoperative survival was markedly affected: 10,5% after 5 years in the first group as against 41% in the second. Five-year life expectancy was therefore increased by a factor of 4 in spite of 9 N+ cancers. In the 2nd group of 19 patients operated upon and regularly followed up 3 years and more 7 are alive. True 5 year survival rate in the 2nd group was therefore 35% as against 10% in the first group. Note that 2 of the 9 N+ patients are alive after 3 years. Aggressive therapy in the 2nd group also drastically reduced pelvic recurrence rate, which dropped from 8 (42,1%) in the first group to 1 (4,5%) in the second. In contrast, the major cause of death (7 cases = 31,8%) in the 2nd series was the development of metastases, without evidence of any pelvic recurrence. The effect of routine chemotherapy is being investigated.