ANALYSIS OF FAILURE FOLLOWING DEFINITIVE RADIOTHERAPY FOR INVASIVE TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

Purpose: To assess prognostic factors for bladder relapse and distant failure following definitive radiotherapy for invasive transitional ce ll carcinoma (TCC) of the bladder. Methods and Materials: Retrospectiv e review of patients treated in the period 1977 to 1990 by definitive radiotherapy. The factors studied included age, sex, T stage, histolog ical grade, tumor multiplicity, ureteric obstruction, total radiation dose, and use of neoadjuvant chemotherapy, The endpoints studied were bladder relapse and distant failure. Results: There were 342 patients with a mean follow-up time of 7.9 years. Bladder relapse was observed in 159 patients, The overall actuarial bladder relapse rate at 5 years was 55% (SE = 3%). Prognostic factors for a higher bladder relapse ra te were: tumor multiplicity (p < 0.001), presence of ureteric obstruct ion (p = 0.001), and higher T stage (p = 0.044), Distant failure occur red in 39 patients, The overall actuarial distant failure rate at 5 ye ars was 28% (SE = 3%). Prognostic factors for a higher distant failure rate were: ureteric obstruction (p = 0.003) and higher T stage (p = 0 .030). Conclusion: In our study, patients with invasive bladder TCC fe ll into distinct prognostic groups determined by the three independent factors, ureteric obstruction, tumor multiplicity, and T stage. These factors provided estimated risks of bladder relapse by 5 years which ranged from 34% to 91%. Knowledge of these prognostic factors can help in the selection of patients more suited for bladder preservation by definitive radiotherapy.