[Pre-operative radiotherapy, conventional or accelerated, for invasive bladder cancer. Objectives and radiation modalities. Results and complications].

OBJECTIVE: To present the experience of La Fe Hospital and the Institute of Oncology of Valencia with preoperative radiotherapy for bladder cancer and review the literature. METHODS: The principles of radiotherapy are discussed and the most important series reported in the English literature (Memorial Sloan Kettering, M.D. Anderson, London Institute of Urology and Rotterdam Radiotherapy Institute) and the largest published Spanish series (Ramon y Cajal Hospital) are reviewed. Furthermore, the results achieved in 123 patients treated between 1982 and 1989 at the Urology and Radiotherapeutic Oncology services of La Fe Hospital and the IVO experience with accelerated radiotherapy (20 Gy in 5 fractions) immediately followed by radical cystectomy are presented. RESULTS: The five-year survival ranged from 39% to 66%. Distant metastasis, which occurred in more than 50% of the patients, was the most common cause of failure. Comparison of the complication rates of the different series is difficult to perform. The operative mortality ranged from 2.4% to 10% and was 8% in our series. Preoperative radiotherapy does not appear to increase the number of postoperative complications. By multivariate analysis, lymph node involvement was the only significant factor that influenced survival in our series. CONCLUSIONS: It cannot be concluded from the analysis of the prospective and randomized studies that preoperative radiotherapy improves survival in patients with invasive bladder cancer. However, some authors have reported that patients with T3b tumor might benefit from this therapeutic modality.