Chemotherapy, radical irradiation plus salvage cystectomy for bladder cancer--severe late small bowel morbidity.

A proportion of patients with invasive bladder cancer are treated with radical irradiation and salvage cystectomy. The use of neo-adjuvant chemotherapy is being widely investigated. Five patients with invasive bladder cancer at Groote Schuur Hospital have undergone salvage cystectomy after neo-adjuvant chemotherapy and radical irradiation. Two of these patients had severe small bowel morbidity while clear of carcinoma and this was fatal in one patient. In our historical series of 30 patients who had salvage cystectomy after radical irradiation alone, there was only one patient with similar small bowel morbidity. There may be an increase in small bowel morbidity from neo-adjuvant chemotherapy in patients who are treated to clinical tolerance by irradiation and who then require a cystectomy.