Combined pre- and postoperative adjuvant radiotherapy for bladder cancer: results of RTOG/Jefferson Study

This paper presents the results of adjuvant "sandwich" radiotherapy for bladder cancer in 65 patients treated in a Radiation Therapy Oncology Group (RTOG) phase II study and at Thomas Jefferson University Hospital. In this approach of adjuvant therapy, patients with clinical stages B or C bladder cancer were given low dose preoperative irradiation (500 rads) to the whole pelvis on the day before or on the day of surgery. Following cystectomy, patients were pathologically staged. Those with high grade (III or IV) stage B1 tumors or stages B2 or C were given 4500 rads in five weeks postoperative radiation. Thirty-four of these 65 patients were entered in the RTOG protocol and 31 in the Jefferson Study. TWenty patients had early lesions (stage 0, A or B1, grade I-II) and did not receive postoperative irradiation. Six patients had stage D cancer and were given palliative therapy. Of 39 patients eligible for postoperative irradiation, 29 received the full course of pre- and postoperative irradiation. Ten patients did not receive treatment. Follow-up ranged from six months to three years with a median of 18 months. Treatment was extremely well tolerated. Incidence of major complications was 6% (4/65). Local control of disease was excellent, with no failures in pelvis response. Actuarial survival at three years is 78%. At this preliminary analysis, these survival results appear to be better than those obtained with other approaches using preoperative irradiation and surgery.