PREOPERATIVE IRRADIATION FOR CARCINOMA OF THE BLADDER

D ESPITE advances in the application of surgery and irradiation the treatment of bladder carcinoma remains unsatisfactory. Five year survival rates following radiation therapy approximate 20 per cent for all patients seen in a large radiotherapy department,2’8 and 28 per cent for those with invasion of muscle or perivesical tissue. Similar rates have been achieved by surgery in a selected population suitable for operation.’ With either method, treatment failure is due to locally recurrent pelvic disease in the majority of patients.8” Improved tumor control rates in animal systems subjected to preoperative irradiation suggested the use of this technique in the treatment of bladder cancer.34 We wish to present the philosophy and early results of such a program carried out at the Presbyterian Hospital of the ColumbiaPresbyterian Medical Center. Preoperative radiotherapy programs range in purpose from devitalization of cells and alteration of the tumor bed to sterilization of tumor which may not be removed at operation. The first purpose can be achieved with a low-moderate radiation dose, but the latter requires doses of the order of 5,000-7,000 rads. Our experience and that of others showed increased morbidity and operative difficulty following a full course of radiotherapy. Therefore, a program of moderate dose irradiation, 3,000 rads in 3 weeks, was designed to augment the basic surgical attack without interfering with its accomplishment.7 The guiding surgical philosophy was to preserve bladder function, treating by endoscopic resection and avoiding cystectomy whenever clinically feasible.