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Objective To compare the result of T2/T3 transitional cell carcinoma (TCC) of the urinary bladder after segmental cystectomy, treated by postoperative radiation plus intravesical chemotherapy and postoperative intravesical chemotherapy alone.Methods From 1985 to Dec.1995 patients with T2/T3 TCC bladder cancer who had been treated by segmental cystectomy were eligible for this retrospective analysis. Fifty-eight patients received postoperative radiotherapy plus intravesical chemotherapy (RT+IVC) and 35 patients were given postoperative intravesical chemotherapy (IVC) with thio-TEPA or calmette-Gue'rin bacilli (BCG). For radiation,8 or 18 ?MV X-ray was given with total dose of 50-60 ?Gy. Vesicoclysis was performed on 50-60 mg thio-TEPA twice per week and 0.5 mg BCG per week.Results The 3-year local control rates of RT+IVC and IVC groups were 68.6% and 48.2% showing a difference statistically significant (? 2=4.08,P=0.044).The 3- and 5-year survival rates of RT+IVC and IVC groups were 70.7%,49.5% and 59.9%,35.7% ,showing no significant difference (? 2=1.77,P=0.184). Among the 5 year survivors of the RT+IVC patients, 78.6% had their bladder preserved. Though untoward radiation reactions were severer, they were tolerated well.Conclusions Combined radiation therapy plus intravesical chemotherapy is indicated for T2/T3 bladder cancer after segmental cystectomy. Multimodality therapy is more favored to improve both the local control and the possibility of preserving the bladder.
RESUMO
Objective To evaluate the local control effect of radiotherapy and intravesical chemotherapy following bladder preserving surgery for musculoinvasive bladder cancer. Methods Twenty three patients with muscle invasive bladder cancer were treated by bladder preserving surgery followed by external radiation ( mean dose 52.5 Gy) combined with intravesical mitomycin infusion after bladder preserving operation (study group).For comparison, 29 similar patients received the same treatment without radiation served as control (control group).Results All patients in the study group completed their designed treatment,except two patients whose protocol was interrupted for 3 days and one week due to acute cystitis. The mean follow up duration was 41.6 months. The 3 year local recurrence rates were 18.8% in the study group and 44.8% in the control group(P=0.026).The 3 year distant metastasis rates were 18.2% and 24.1% (P=0.437),and the 3 year overall survival rates were 81.8% and 86.2% (P=0.670),respectively. Conclusion It is demonstrated that adjuvant radiotherapy and intravesical infusion chemotherapy following organ preserving surgical procedure are encouraging by giving favorable local control for musculoinvasive bladder cancer.