Radiotherapy and cystectomy for T3 bladder carcinoma

The survival of 102 patients with category T3 transitional cell carcinoma of the bladder treated by pre-operative radiotherapy and radical cystectomy has been analysed according to the degree of down-staging of tumour as assessed by the depth of infiltration of cancer in the operative specimen. Five-year survival was 60% for patients showing evidence of down-staging compared with 30% when persistent deeply invasive tumour was present at the time of cystectomy. Analysis of available data suggests that survival of patients with category T3 bladder cancer is determined by the response of the tumour to initial radiotherapy rather than the dose of radiotherapy or the addition of cystectomy. Despite radical treatment, the survival of patients with locally advanced bladder cancer is poor; alternative, more effective forms of therapy should be sought.