[Radiotherapy in the interdisciplinary approach to the treatment of bladder carcinoma]

Abstract

Bladder cancer accounts for approximately 3% of all malignancies. About 70% of bladder cancers are superficial tumors (Ta, Tis, T1), the remaining 30% are muscle-invasive (T2-4). Important prognostic factors include TNM-stage, histologic grade, multifocality, associated Tis, and residual tumor after TUR. Superficial cancers are managed by TUR and, if necessary, intravesical chemotherapy, and bladder preservation is possible. In case of T1G3-cancers, we favour TUR plus irradiation with a moderate dose instead of cystectomy. Even advanced bladder cancers may be treated by an organ sparing approach. TUR plus radiotherapy or radiochemotherapy offer comparable survival figures and local control rates as compared to radical cystectomy. The 5-year survival rates are 60-70% for T1-2, 40% for T3, and 15% for T4-tumors. About 70% of long-term survivors maintain a functioning bladder. Radiochemotherapy (RCT) with platin compounds is equally effective but less toxic as compared to multi-agent chemotherapy or intraarterial administrations. We do not recommend preoperative radiotherapy or RCT with planned cystectomy because of the definitive organ loss. Optimal treatment results are achieved by complete TUR prior to irradiation. Persistent or recurrent tumor after radiotherapy requires salvage cystectomy. Intravesical recurrences in the spared bladder have a good prognosis. Adjuvant chemotherapy of bladder cancer is not established. Neoadjuvant chemotherapy may result in 20-30% complete remissions, but these figures are lower than those after radiotherapy or radiochemotherapy. Nevertheless, adjuvant treatment protocols are necessary because of the fact that even sophisticated local treatment with increased local control has not yet improved the overall survival rates.