Contemporary Cystectomy with Pelvic Node Dissection Compared to Preoperative Radiation Therapy Plus Cystectomy in Management of Invasive Bladder Cancer

Between August 1971 and August 1982, 197 consecutive patients underwent single stage radical cystectomy with pelvic lymph node dissection and urinary diversion as definitive management of high grade, invasive bladder cancer. In 100 patients 1,600 rad of radiation therapy were given for 4 days preoperatively and 97 patients underwent an operation only. Although not constituting a prospective randomized study, an analysis of these 2 groups of patients managed during an 11-year period by the same surgical team, using identical surgical technique, provides useful information that questions the benefit of preoperative radiation therapy in the management of high grade, invasive bladder cancer. Other factors, such as improved surgical technique with meticulous pelvic node dissection as well as better preoperative and postoperative care, may be responsible for survival results of contemporary surgery only that equal those reported following combination therapy protocols using preoperative radiation therapy. Contemporary surgery with or without preoperative radiation therapy yielded a 5-year survival rate free of tumor of 75 per cent for patients with pathologic stages P2 and P3A disease, 44 per cent with P3A and P3B disease, and 36 per cent with P4 disease and positive pelvic nodes.