Postoperative radiation therapy for muscle-invading bladder carcinoma

From 1974-1980, 15 patients with pT2-4 bladder carcinoma received adjuvant postoperative radiation therapy (XRT). The extent of initial surgery varied (six radical cystectomy, 5 partial cystectomy, four "total" transurethral resection). The planned XRT was 4,000-5,040 rads in 5-6 weeks to the pelvis (achieved in 14/15 patients) followed by a bladder boost in noncystectomized patients (achieved in 8/9). Survival at two years and five years was 54% (7/13 patients) and 27% (3/11 patients), respectively. Local-regional disease control (minimum two-year follow-up) was achieved in 7/11 (63%). Of seven patients alive at least two years later, small bowel complications (chronic diarrhea, obstruction) occurred in two; these latter patients each had had radical cystectomy. Adjuvant postoperative XRT may be useful in the multimodality management of patients with bladder carcinoma, especially those identified as high risk after pathologic staging and initial surgery. The poor regional control rate and relatively high incidence of complications seen in this and previous studies suggest that improved radiation technique is needed, both to ensure adequate coverage of the volume at risk and to minimize complications. Representative portals are shown to illustrate these features.