Combined radiotherapy, surgery and chemotherapy in carcinoma of the bladder.

A 5-year experience in 109 patients with cancer of the bladder treated by combination radiotherapy, surgery and chemotherapy is reviewed. This combined therapy did not improve the poor outlook for patients with invasive (stages C or D) tumors. The study reveals that, when the bladder is preserved in stage B carcinoma by partial cystectomy or endoscopic excision, postoperative radiotherapy should be added to bring the total dosage to a full therapeutic level. In large bulky Stage A tumors preoperative radiotherapy seems to be distinctly valuable in reducing tumor size and clarifying the extent of pathology. It thus aids in the selection of the surgical approach to the tumors. More definitive biopsies could be done after the preoperative radiation. In such patients preoperative radiation make technically possible partial cystectomy or endoscopic resection rather than total cystectomy. In these stage A tumors, when the bladder is preserved, postoperative instillations of Thio-TEPA into the bladder is used to supplement the preoperative radiotherapy.