Factors of prognostic and therapeutic significance in patients with bladder cancer

In a two-decade period, 451 patients with bladder cancer were treated by external megavoltage irradiation and/or radical cystectomy at the Memorial Sloan-Kettering Cancer Center. Radical cystectomy alone was performed in 137 patients. One-hundred nine patients underwent radical cystectomy for cancer recurrence or persistence ± 1 year after radical irradiation averaging 6000 red tumor dose in 6 weeks. Planned preoperative pelvic irradiation either 4000 rad in 4 weeks in 119 patients or 2000 rad in 1 week in 86 patients was followed by radical cystectomy after average intervals of 6 weeks and 2 days, respectively. Similarly more favorable 5-year survival results were observed with prior radial (41 %) or preoperative conventional (43 %) or shorter regimen (42 %) irradiation than with cystectomy alone (33%); especially in high clinical stage B₂-D₁ tumors (27–37% with versus 14% without irradiation), in lesions not larger than 4 cm (50–57 % versus 38 % ), in patients older than 60 years (39–43 % versus 28 % ), in female patients (38–50 % versus 26 %), and in patients who had prior therapeutic tumor resections (41–45% versus 27%). Less favorable 5-year survival results were noted in the four treatment groups (with and without irradiation), in patients with precystectomy obstructive uropathy (28 % ) than in those with normal excretion urograms (46 % ), with tumors larger than 4 cm (26 %) than with smaller lesions (48 % ), with solid (33 %) than with papillary (51 %) tumors, with solitary (36%) than with multifoal (46%) cancers, and in cases with vascular tumor thrombi in the operative specimen (14 %) than in cases without tumor thrombi (41 %).