Treatment of T2/T3 bladder carcinoma: total cystectomy with and without preoperative irradiation.

Total cystectomy with or without preoperative radiotherapy was performed in 122 patients with T2/T3 bladder carcinoma (group 1:42 patients, 23 X 2 Gy; group 2:34 patients, 5 X 4 Gy; group 3:46 patients, 0 Gy). Crude and disease-free survival was 40 and 54%, respectively, in this retrospective study. No survival difference was observed between the different groups. 'Stage reduction' in the cystectomy specimen (P less than T) was the only significant prognostic parameter and was seen in 24, 15 and 18 patients from groups 1, 2 and 3, respectively. Distant metastases were found in 47 patients during follow-up, equally distributed between the 3 groups, but significantly less often in patients with 'stage reduction'. In patients with T2/T3 bladder cancer, the role of precystectomy radiotherapy remains undefined, though there might be a nonidentifiable subgroup of patients (about 20%) who probably benefit from preoperative irradiation. Preferably short-term radiotherapy should be applied. As distant metastases represent the most common reason for treatment failure after total cystectomy, the role of adjuvant systemic chemotherapy has to be explored in further clinical studies.