Treatment of Advanced Bladder Cancer Category T2 T3 and T4a

From 1983 to 1986 183 patients with transitiocellular carcinoma of the urinary bladder, category T2 — T4a, entered a randomized study. The patients were allocated to receive either preoperative irradiation (40 Gy) followed by cystectomy or radical irradiation (60 Gy) followed by salvage cystectomy in case of residual tumor. The two randomization groups were comparable In regard to sex, age, T-categories, tumor size, histological grade and concomitant dysplasia. The two randomization groups included 88 and 95 patients respectively.The treatment plan was followed by 66 patients (75%) in the planned cystectomy group and by 88 (92%) in the radical radiotherapy group of which 27 (28%) were treated with salvage cystectomy.The results showed a trend to a higher survival rate following the combined treatment with preoperative irradiation and cystectomy compared to radical irradiation followed by salvage cystectomy in case of residual tumor, but a statistical significant difference could not be demonstrated. The lack of difference also applied according to the actually given treatment.There was no difference in surgical complications between planned and salvage cystectomy and there were no postoperative deaths among the cystectomized patients. The type of late complications was different in the two treatment groups, but there were no major differences in the number of complications except for the fact that all male patients experienced erective impotence after cystectomy.The T-category, response to radiotherapy and frequency of lymph node metastases were found to be of prognostic importance.Although preoperative irradiation with planned cystectomy tends to give better, but not significantly better results, patients with advanced bladder cancer have an option to choose radical irradiation with the perspective of preserving the bladder function.