The value of computed tomography in the management of bladder cancer.

In an attempt to improve the radiotherapeutic management of patients with bladder carcinoma, we have added computed tomography (CT) scanning of the pelvis and abdomen to conventional evalution, including cystoscopy with bimanual examination under anesthesia. Sixty consecutive new patients were studied from July 1976 to November 1977. Operative findings were correlated with CT scans in 17 patients; 13 had exploration of the abdomen and pelvis at the time of ileal loop diversion and 3 at the time of segmental resection, before irradiation. Only periaortic node biopsy specimens were obtained in the 17th patient. The potential value of CT scanning was investigated in both groups. We conclude that CT scanning: (1) is of value in defining the extent of involvement in the bladder and perivesical tissues, in pelvic soft tissues and nodes, in periaortic nodes, and in fixation to bone; (2) provides for more accurate staging than was possible previously by non-invasive techniques; (3) allows for technically simpler display of multiple 2-dimensional computerized radiation therapy treatment plans, thus simulating 3-dimensional planning; (4) allows the tumor response to irradiation to be followed with time, facilitating surgical planning; and (5) permits detection of residual and recurrent tumor.