Observations on definitive cobalt 60 radiation for cure in bladder carcinoma: 15-year followup

Radiation therapy will result in tumor disappearance in a select number of patients. However, it does not prevent local recurrence and, therefore, the patient continues at risk. Tumor recurrence was noted in more than half the patients in our series and more than 50 per cent of these patients experienced multiple recurrences. A functional bladder was maintained in nearly 60 per cent of the patients. Survival in 11 patients in category 1 with radiation therapy and subsequent non-ablative extirpative surgical procedures in 8 patients was equivalent to series treated by preoperative irradiation and cystectomy. In contrast the 14 patients in category 2 had a survival rate that was appreciably lower than that obtained with preoperative irradiation followed by cystectomy. There was a significantly increased morbidity associated with an open operation in the treatment of recurrence in the irradiated patient. We would advocate preoperative irradiation followed by cystectomy in the patients with high grade and high stage disease. The value of single versus adjuvant forms of therapy for patients with diffuse, rapidly recurring low grade and low stage disease would be determined best by a randomized prospective study. Evidence from this series suggests that irradiation improved over-all survival in this category.