T3 bladder cancer--the case for salvage cystectomy.

Seven hundred and four patients with bladder cancer treated by radiotherapy at the London Hospital between 1965 and 1974 have been followed for a minimum period of 5 years. Invasive tumours were usually treated by radical radiotherapy. Cystectomy was reserved for patients whose tumours did not respond to radiation, recurred later on, or who developed complications from radiotherapy. The crude 5-year survival rate for T3 tumours in this series was 38%--similar to that obtained in other centres using pre-operative radiation followed by cystectomy, but this overall figure conceals the important difference between 2 distinct tumour populations. Nearly half of these tumours appear to be radiosensitive, giving a 56% crude 5-year survival rate for T3 tumours. The remainder are radioinsensitive, with only a 17% crude 5-year survival rate for T3 tumours. When there is a good initial response to radiotherapy there would seem to be no necessity to insist upon cystectomy.