1985 Volume 76 Issue 4 Pages 554-559
Of 52 patients with high stage (T2-4), or high grade and low stage (T1) bladder tumor during the 7 year-period from 1975 to 1981, 23 patients were treated with preoperative irradiation and total cystectomy, 4 with preoperative irradiation and partial cystectomy, and 25 with curative irradiation therapy. The dose of the irradiation was 2000 or 4000rads (whole pelvis) in the preoperative irradiation group, and 5000-6000rads (4000rads to whole pelvis followed by 1000-2000rads to bladder region) in the curative irradiation group. The results were as follows: 1) The three and five year survival rates of patients with T1, T2 and T3 tumor treated with preoperative radiation and surgery were 100%-100%, 80-43% and 45%-23%, whereas those of patients treated with curative irradiation were 73%-62%, 26%-0% and 0%-0%, respectively. 2) Downstaging of tumor was observed in 45% of overall patients. According to histologic growth pattern of tumors, the rate of downstaging was markedly high, (100%-7/7) in non-papillary microinvasive carcinoma compared to superficial papillary carcinoma (50%-4/8) and invasive carcinoma (31%-10/32). 3) The three and five year survival rates of patients with invasive carcinoma (T2-4) were 100% and 57%, respectively, in 6 patients who achieved downstaging of tumor, whereas they were 50% and 11%, respectively, in 16 patients who didn't achieve tumor downstaging by preoperative irradiation. 4) The incidence of local (pelvic) recurrence in the preopeartive irradiation group was low (7%-2/27) compared to the curative irradiation group (32%-8/25). However, the incidence of distant metastasis was high (>20%) in both groups. 58% of distant metastases occurred within one year and 92% within 3 years.
