PRESENTATION, METHODS OF DIAGNOSIS AND THERAPY FOR PELVIC RECURRENCE FOLLOWING RADICAL CYSTECTOMY FOR TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

Purpose: We evaluated the presentation, methods of diagnosis and treat ment of pelvic recurrence following radical cystectomy for transitiona l cell carcinoma of the bladder. Materials and Methods: We reviewed th e records of 33 patients who underwent radical cystectomy for transiti onal cell carcinoma between May 1960 and August 1995 at our cancer cen ter and who later had pelvic recurrence. Results: The majority of pati ents underwent cystectomy for clinically advanced transitional cell ca rcinoma. Median time from cystectomy to recurrence was 10 months. Of t he patients 25 were symptomatic (76%) at the time recurrence was diagn osed. Recurrence was discovered by digital rectal examination in 4 asy mptomatic patients (12%) and by routine pelvic imaging in 2, Treatment included chemotherapy, surgery or radiation (alone or in combination) . Of the 33 patients 29 died of progressive disease with a median surv ival of 7 months from the time of recurrence, and 4 remained free of d isease at 7, 14, 26 and 95 months after local recurrence. Despite the poor survival rate following treatment 11 of 14 patients had complete resolution of symptoms following chemotherapy. Conclusions: The progno sis of patients with local recurrence is poor regardless of therapy. T hese recurrences are often symptomatic but careful post-cystectomy tum or surveillance, including digital rectal examination and pelvic imagi ng, provides an opportunity to diagnose local recurrences when they ma y be amenable to therapy. Systemic chemotherapy offers excellent palli ation for symptomatic patients.