Radiotherapy is an effective treatment for high-risk T1-bladder cancer

Purpose: Current treatment options for high-risk superficial T1-bladder can cer (Grade 3, associated Tis, multifocality, tumor diameter > 5 cm or multi ple recurrences) include early cystectomy or the goal of organ preservation by adjuvant intravesical therapy after transurethral resection (TU RE). We have evaluated the efficacy of adjuvant radiotherapy or radiochemotherapy on Local control, bladder preservation, recurrence rate and Long-term survi val after TURB of high-risk T1-bladder cancer. Patients and Methods: From May 1982 to May 1999, a total of 74 patients wit h T1-bladder cancer were treated by either radiotherapy (n = 17) or concomi tant radiochemotherapy (n = 57) after TURB. Radiotherapy was initiated 4 to 8 weeks after TURB; a median dose of 54 (range: 45 to 60) Gy was applied t o the bladder with daily fractions of 1.8 to 2.0 Gy. Since 1985 chemotherap y has been given in the 1st and 5th week of radiotherapy and consisted of c isplatin (25 mg/m(2)/d) in 33 patients, carboplatin (65 mg/m(2)/d) was admi nistered in 14 patients with decreased creatine clearance (< 50 ml/min). Si nce 1993 a combination of cisplatin (20 mg/m(2)/d) and 5-fluorouracil (600 mg/m(2)/d) was applied to 10 patients. Salvage cystectomy was recommended f or patients with refractory disease or invasive recurrences. At the time of analysis, the median follow-up for surviving patients was 57 (range: 3 to 174) months. Results: After radiotherapy/radiochemotherapy, a complete remission at rest aging TURB was achieved in 62 patients (83.7%), 35 of whom (47% with regard to the total cohort of the 74 treated patients) have been continuously fre e of tumor, 11 patients (18%) experienced a superficial relapse and 16 pati ents (26%) showed tumor progression after initial complete response. Overal l-survival was 72% at 5 years and 50% at 10 years with 77% of the surviving patients maintaining their own bladder at 5 years. Negative prognostic fac tors for cancer-specific survival were non-complete (R1/2) initial TURB (p = 0.12) and recurrent disease (p = 0.07); combined radiochemotherapy was mo re effective than radiotherapy alone (p = 0.1). Conclusion: Adjuvant radiotherapy/radiochemotherapy offers an additional op tion in high-risk superficial bladder cancer with a high chance of cure and bladder preservation. The ultimate value of radiotherapy in comparison wit h other treatment options should be determined in randomized trials.