BLADDER-CANCER DEFINITIVE RADIATION-THERAPY OF MUSCLE-INVASIVE BLADDER-CANCER - A RETROSPECTIVE ANALYSIS OF 317 PATIENTS

Background. The role of radiation therapy as curative treatment of mus cle-invasive bladder cancer was to be analyzed. Methods. From 1980-199 0, 308 patients with transitional cell carcinoma of the urinary bladde r received definitive pelvic radiation therapy (nominal standardized d ose greater than or equal to 1700 ret). T categorization was based on clinical examination assessing the palpability of the bladder tumor an d its extent (TNM 1978/1982). Results. The cancer-specific 5-year surv ival rate for all patients was 24% (crude survival, 20%). The 135 pati ents with T2/T3a tumors lived significantly longer (5-year survival, 3 8%) than those with greater than or equal to T3b tumors (5-year surviv al, 14%). In the former group of patients, age (75 years and younger v ersus older than 75 years) was significantly correlated with a favorab le outcome. The cancer-specific 2-year survival was significantly corr elated to clinical response assessed 3-4 months after radiation therap y was 72%, 38%, and 10% in cases of complete response, partial respons e, and no response/inevaluability, respectively. In a multivariate ana lysis, the T categorization, patient age, serum creatinine level (less than or equal to 150 mumol/l versus greater than 150 mumol/l), and ra diation therapy schedule predicted the 5-year survival rate. Conclusio ns. The clinical T category (less-than-or-equal-to T3a versus greater- than-or-equal-to T3b), based on bimanual palpation, represents an impo rtant prognostic parameter, if done by clinicians experienced in onco- urology. High-dose radiation therapy offers a reasonable chance for lo ng-term survival in patients with T2/T3 tumors confined to the bladder wall, especially in patients younger than 76 years. Greater than or e qual to 80% of patients with more extended tumors (greater than or equ al to T3b) and those older than 75 years of age are not curable by rad iation therapy alone. In these patients palliative treatment modalitie s should be considered, in particular if cisplatin-based chemotherapy is not feasible.