Radical irradiation of T2 grade III and T3 bladder cancer--tumor response and prognosis.

A retrospective review was undertaken of the records of 69 patients treated by radical irradiation between 1972 and 1977 for T2 Grade III and T3 bladder cancer. Twenty-six of the patients were treated to a tumor dose of 54 Gy in 2 Gy fractions using five daily fractions per week and 24 of the patients were treated to a tumor dose of 48.6 Gy in 3.47 Gy fractions given tri-weekly. The tumor response and its relationship to patient five year survival with bladder conservation was determined. Tumor response was assessed on the basis of the documented gross cystoscopic findings between 6 and 12 months after radiotherapy. This could be done in 63 of the 69 patients. The complete response rate was 43%. The five year survival rate with bladder conservation for all the patients in the study was 24%; for those with a complete response at cystoscopy, 54%; and for those failing to achieve a complete response, 5.8%. A statistically significant improvement in survival with bladder conservation for patients with complete response was found in both subgroups of uniformly treated patients. A 17% incidence of severe late gastrointestinal tract complications was noted in the subgroup of patients treated with large radiation fractions. These results confirm the prognostic value of the tumor response at cystoscopy after radical radiotherapy, expand the total dose or TDF range over which it has been observed and document its occurrence with an unconventional radiation fractionation schedule.