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Objective To study the efficacy,late complications and prognostic factors of postopera-tive radiotherapy for bladder cancer: Methods Between July 1995 and January 21307,109 patients with primary bladder cancer who had received adjuvant pelvic radiation therapy were retrospectively analyzed. The age ranged from 41 to 94 (median 68) years. There were 29 patients with T1 disease,60 with T2,17 with T3, 3 with T4, and 7 with positive lymph node. Three-dimensional radiotherapy was given with a median total dose of 49.2 Gy(39.3 -62.2 Gy) in conventional fractionation after surgery. Field-in-field intensity modu-lated radiotherapy was given to 57 patients. Results The total follow-up rate was 98% ,with a median fol-low up time of 36(2-144) months. The 1-,3- and 5-year local control rate was 63% ,47% and 42% ,respec-tively. The 1-,3- and 5-year overall survival rate was 80% ,48% and 37% ,respectively. Among the 109 pa-tients,33 died of tumor progression or metastasis,42 showed local recurrence,and 22 had lymph node metas-tasis. According to the RTOG criteria,grade 1,2,3 and 4 radiation related early urological side effects were 22% ,59% ,12% and 1% ,respectively;The corresponding late urological side effects were 29% ,28% ,2% and 1%, respectively. Two patients underwent whole bladder cystectomy due to the radiation related side effects. Conclusions Postoperative three-dimensional radiotherapy, achieving high response rate with tol-erable side effects, can be offered as an alternative option to the radical cystectomy in the bladder conserving treatment.
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Background and purpose:Radical cystectomy is viewed as the standard treatment for bladder carcinoma,but organ preservation has been attempted for patients with muscle-invasive bladder carcinoma over the past decades as an alternative to radical cystectomy.The majority of studies included transurethral resection of bladder tumor(TURB),radiotherapy,and chemotherapy,as a feasible and safe organ-sparing approach with the similar outcome to radical cystectomy.The current study evaluated the outcomes and complications of the radiation therapy for the patients with bladder cancer,and prognosis factors had been analyzed.Methods:We retrospectively analyzed 21 patients with bladder cancer.The clinical stages of the patients were 15 with T_2;5 with T_3 and 2 with T_4.2 of them were lymph node-positive,16 of patients were pathologically proved as transitional cell carcinoma,4 as adenocarcinoma and 1 as transitional cell carcinoma plus squamous cell carcinoma.Conventional fractionation radiotherapy was given at a median dose of 54.5Gy(ranged 49.2-69.9 Gy) after surgery.Kaplan-Meier method and Logrank method were used for the statistical analysis.Results:Median follow-up was 32 months.The overall survivals at 1 year,3 years and 5 years were 90.5%,47.1%,and 36.7% respectively.The local disease free rates were 95.0%,62.4%,and 47.5% respectively.15 of 16 patients' deaths were related to the tumor.In univariate analysis,only small field irradiation was found as a prognosis factor in survival(?~(2)=5.36,P=0.02).Conclusions:Combined treatment appears to provide high response rates and can be offered as an alternative option to radical cystectomy for selected patients who refuse or are unsuitable for surgery.A large number of patients,multicenter,prospective randomized trial would be desirable to evaluate the role of radiotherapy in the multi-modality treatment of bladder cancer.
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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.
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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.