Klin Onkol 1994; 7(4): 99-107.
In spite of advances in detection and treatment of the urinary bladder cancer, the death rate has remained virtually unchanged for the last 30 years. Although transurethral resection, partial cystectomy, and intravesical chemotherapy are appropriate treatments for low-grade, low-stage tumors, preoperative irradiation followed by planned cystectomy is generally accepted standard treatment for high-grade, deeply invasive, T3a, T3b tumors, with 5-year survival rates as high as 65%. Downstaging in the pathology specimen is an important prognostic factor. Patients with no residual tumor in the surgical specimen can have a 5-year survival rate high as 85%.
Cystectomy is a mutilating procedure that leaves the patient with a permanent ilial conduit and leaves men impotent. Alternative methods of treatment have been sought would enable the patient to retain-normal bladder function while still providing a good chance of long-term disease-free survival. For tumors smaller than 5 cm in diameter, results obtained with a combination of external irradiation and interstitial implant are comparable to those obtained with preoperative irradiation and cystectomy. In another approach, patients with deeply invasive tumors receive a definitive course of radiation therapy and are followed closely. Patients with no residual tumor at 6 months undergo no further treatment and have a 5-year survival rate of 56%. Patients with residual tumor undergo salvage cystectomy and have a 5-year survival rate of 40%. A recent prospective randomized clinical trial would seem to indicate that patients over age 60 need not undergo cystectomy but will do as well when treated with radical course of external beam therapy. A promising alternative to preoperative irradiation and surgery is to treat the deeply invacive carcinomas of bladder with concomitant chemotherapy used as a radiation senzitizer. New combined modalities of treatment hold the promise of providing the patients a better chance of long-term survival, as well as better guality of life.
