SURVIVAL AFTER CURATIVE TREATMENT OF MUSCLE-INVASIVE BLADDER-CANCER

This retrospective study includes 534 patients who had curatively inte nded treatment for T2/T3/T4a bladder cancer at the Norwegian Radium Ho spital during the period 1980-1990. Total cystectomy preceded by preop erative radiotherapy represented the treatment of choice in 263 patien ts (CysCr). High-dose radiotherapy was applied in 271 patients in whom total cystectomy could not be performed (RadGr). From 1985 neo-adjuva nt cisplatin-based chemotherapy was increasingly used. The 5-year crud e survival rate for all patients was 35% with 40% for CysCr and 22% fo r RadGr, In CysGr the 5-year survival rate was highest (63%) for patie nts with <pT2 and lowest for pN+ patients (13%). The following indepen dent prognostic parameters were identified for the total group: T cate gory, trial participation, treatment, creatinine, haemoglobin, age and time since initial diagnosis, No significant difference in survival w as found when comparing the treatment results obtained before and afte r 1985. In spite of the introduction of multimodality therapy the trea tment results for T2/T3/T4a bladder cancer have remained unchanged. Ho wever, subgroups of patients may benefit from this approach allowing b ladder conservation in selected cases, More effective adjuvant regimen s have to be developed for high-risk patients (pT3b/pN+).