Salvage cystectomy after radiation failure in patients with bladder carcinoma

Thirty-two patients with cancer of the bladder definitively treated with irradiation had radical cystectomy without lymphadenectomy for treatment of recurrent or persistent tumor. Preoperative clinical staging was accurate in distinguishing between superficial and deeply invasive disease in 94% of patients, while in 44% and pathologic stage were identical. There were no postoperative deaths. Fourteen patients have no evidence of disease 11 to 75 months post-operatively, 14 developed recurrent disease two to 20 months after surgery, and four died of other causes after satisfactory recovery from surgery. Assessment of clinical stage offers the best prognostic indication of survival, as all patients whose tumor was 15 (carcinoma in situ) or T1 survived without developing recurrent whereas only six patients with stage T3 or greater are alive without recurrent disease. Cystectomy can thus be recommended for selected patients with bladder cancer who have failed definitive irradiation therapy.