High Dose, Short Course Preoperative Radiation Therapy and Immediate Single Stage Radical Cystectomy with Pelvic Node Dissection in the Management of Bladder Cancer

No AccessJournal of Urology1 Apr 1982High Dose, Short Course Preoperative Radiation Therapy and Immediate Single Stage Radical Cystectomy with Pelvic Node Dissection in the Management of Bladder Cancer Donald G. Skinner, Jerome P. Tift, and Joseph J. Kaufman Donald G. SkinnerDonald G. Skinner More articles by this author , Jerome P. TiftJerome P. Tift More articles by this author , and Joseph J. KaufmanJoseph J. Kaufman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)53986-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail During a 9-year interval 131 patients with high grade invasive or multifocal bladder cancer were treated with high dose, short course preoperative radiation therapy (1,600 rad during 4 days) followed immediately by single stage radical cystectomy with pelvic node dissection. The operative mortality was 1 of 131 patients (0.7 per cent), with a major complication rate prolonging hospitalization of 22 per cent. Analysis of the data reveals a surprising incidence of positive nodes in patients thought to have superficially invasive disease: 12 per cent in patients staged clinically to have multifocal stage T1 or T1S cancer. Over-all, 34 patients in this series had positive nodes (25 per cent), including 2 of 41 (5 per cent) with stage P1 or P1S, 6 of 20 (30 per cent) with stage P2, 4 of 13 (31 per cent) with stage P3A, 18 of 28 (64 per cent) with stage P3B and 4 of 8 (50 per cent) with stage P4 disease. There was excellent local control of the primary disease with this protocol, since only 6 patients (5 per cent) had pelvic recurrence as the first indication of failure: 1 of 59 patients with pathologic stages O and A, 0 of 23 with stages B1 and B2, 0 of 10 with stage C and 5 of 38 (14 per cent) with pathological stage D cancer. The 5-year survival according to pathologic stage was 81 per cent for patients with stages P0, P1S and P1 disease, 53 per cent with stage P2, 37 per cent with stage P3, 25 per cent with stage P4, 79 per cent with stages O and A, 58 per cent with stages B1 and B2, 44 per cent with stages B2 and C, 36 per cent with stage D disease and 36 per cent for patients with positive nodes. Survival and pelvic recurrence rates with this combination are similar to those reported using higher doses of short course preoperative radiation therapy or more prolonged standard fractionation protocols, raising questions as to the significance of preoperative therapy. Despite improved surgical techniques with lower morbidity nearly 50 per cent of the patients with deeply invasive disease die of metastatic disease, implying the need for effective adjuvant systemic therapy. © 1982 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHAUTMANN R and SIMON J (2018) ILEAL NEOBLADDER AND LOCAL RECURRENCE OF BLADDER CANCER: PATTERNS OF FAILURE AND IMPACT ON FUNCTION IN MENJournal of Urology, VOL. 162, NO. 6, (1963-1966), Online publication date: 1-Dec-1999.HALEBLIAN G, SKINNER E, DICKINSON M, LIESKOVSKY G, BOYD S and SKINNER D (2018) HYDRONEPHROSIS AS A PROGNOSTIC INDICATOR IN BLADDER CANCER PATIENTSJournal of Urology, VOL. 160, NO. 6 Part 1, (2011-2014), Online publication date: 1-Dec-1998.WESTNEY O, PISTERS L, PETTAWAY C, TU S, POLLACK A and DINNEY C (2018) PRESENTATION, METHODS OF DIAGNOSIS AND THERAPY FOR PELVIC RECURRENCE FOLLOWING RADICAL CYSTECTOMY FOR TRANSITIONAL CELL CARCINOMA OF THE BLADDERJournal of Urology, VOL. 159, NO. 3, (792-795), Online publication date: 1-Mar-1998.Freiha F, Reese J and Torti F (2018) A Randomized Trial of Radical Cystectomy Versus Radical Cystectomy Plus Cisplatin, Vinblastine and Methotrexate Chemotherapy for Muscle Invasive Bladder CancerJournal of Urology, VOL. 155, NO. 2, (495-500), Online publication date: 1-Feb-1996.Yoshimura I, Kudoh J, Saito S, Tazaki H and Shimizu N (2018) p53 Gene Mutation in Recurrent Superficial Bladder CancerJournal of Urology, VOL. 153, NO. 5, (1711-1715), Online publication date: 1-May-1995.Thrasher J and Crawford E (2018) Current Management of Invasive and Metastatic Transitional Cell Carcinoma of the BladderJournal of Urology, VOL. 149, NO. 5 Part 1, (957-972), Online publication date: 1-May-1993.Brendler C, Steinberg G, Marshall F, Mostwin J and Walsh P (2018) Local Recurrence and Survival Following Nerve-Sparing Radical CystoprostatectomyJournal of Urology, VOL. 144, NO. 5, (1137-1140), Online publication date: 1-Nov-1990.Prout G, Shipley W, Kaufman D, Heney N, Griffin P, Althausen A, Bassil B, Nocks B, Parkhurst E and Young H (2018) Preliminary Results in Invasive Bladder Cancer with Transurethral Resection, Neoadjuvant Chemotherapy and Combined Pelvic Irradiation Plus Cisplatin ChemotherapyJournal of Urology, VOL. 144, NO. 5, (1128-1134), Online publication date: 1-Nov-1990.Dreicer R, Messing E, Loehrer P and Trump D (2018) Perioperative Methotrexate, Vinblastine, Doxorubicin and Cisplatin (M-VAC) for Poor Risk Transitional Cell Carcinoma of the Bladder: An Eastern Cooperative Oncology Group Pilot StudyJournal of Urology, VOL. 144, NO. 5, (1123-1126), Online publication date: 1-Nov-1990.Bruce Malkowicz S, Nichols P, Lieskovsky G, Boyd S, Huffman J and Skinner D (2018) The Role of Radical Cystectomy in the Management of High Grade Superficial Bladder Cancer (PA, P1PIS and P2)Journal of Urology, VOL. 144, NO. 3, (641-645), Online publication date: 1-Sep-1990.Voges G, Tauschke E, Stöckle M, Alken P and Hohenfellner R (2018) Computerized Tomography: An Unreliable Method for Accurate Staging of Bladder Tumors in Patients who are Candidates for Radical CystectomyJournal of Urology, VOL. 142, NO. 4, (972-974), Online publication date: 1-Oct-1989.Skinner D and Lieskovsky G (2018) Contemporary Cystectomy with Pelvic Node Dissection Compared to Preoperative Radiation Therapy Plus Cystectomy in Management of Invasive Bladder CancerJournal of Urology, VOL. 131, NO. 6, (1069-1072), Online publication date: 1-Jun-1984.Montie J, Straffon R and Stewart B (2018) Radical Cystectomy without Radiation Therapy for Carcinoma of the BladderJournal of Urology, VOL. 131, NO. 3, (477-482), Online publication date: 1-Mar-1984.Whitmore W (2018) Editorial CommentJournal of Urology, VOL. 128, NO. 1, (36-36), Online publication date: 1-Jul-1982.Skinner D (2018) Management of Invasive Bladder Cancer: A Meticulous Pelvic Node Dissection Can Make a DifferenceJournal of Urology, VOL. 128, NO. 1, (34-36), Online publication date: 1-Jul-1982. Volume 127Issue 4April 1982Page: 671-674 Advertisement Copyright & Permissions© 1982 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Donald G. Skinner More articles by this author Jerome P. Tift More articles by this author Joseph J. Kaufman More articles by this author Expand All Advertisement PDF downloadLoading ...