SALVAGE CYSTECTOMY AFTER RADICAL IRRADIATION FOR BLADDER-CANCER - PROGNOSTIC FACTORS AND COMPLICATIONS

We have studied 46 patients who underwent salvage cystectomy between M arch 1981 and June 1992 for persistent or recurrent carcinoma after ra dical irradiation for bladder carcinoma. The overall 5-year survival r ate was 43%. There was a higher 5-year survival rate in patients with an incomplete response compared with those with a complete response to their prior irradiation (50 and 36%), in patients with grades 1 or 2 compared with grade 3 histology (75 and 28%), and in patients with T1 or T2 tumours compared with T3 tumours (59 and 32%). The median interv al between commencing irradiation and performing cystectomy was 11 mon ths. In the 25 patients with a prior complete response the median inte rval was 16 months; this was statistically significantly longer than i n the 21 patients with an incomplete response (median interval 7 month s). A worsening of tumour grade and category was found in some patient s when comparing the findings at cystectomy with those prior to irradi ation. This was consistently higher in patients with a prior complete response than in those with an incomplete response. There were 3 death s and 12 non-fatal major complications due to the prior irradiation or surgery, with a mortality rate of 7% and an overall 5-year complicati ons rate of 35%. Only one of the complications occurred in the 13 pati ents treated with conventional 2 Gy fractions alone (5 fractions/week) . Their overall complication rate was statistically significantly lowe r than that of the others. Salvage cystectomy is indicated for selecte d patients with persistent or recurrent disease after radical irradiat ion for bladder cancer- The expectation of a survival rate similar to that found in patients treated with immediate cystectomy may not be ju stified.