Invasive bladder cancer. Prognostic factors and results of radiotherapy with and without cystectomy.

We report the results and complications of treatment in 205 patients with nonmetastatic invasive bladder cancer. Between 1977 and 1982 there were 3 treatment groups: palliative radiotherapy, radical radiotherapy, and pre-operative radiotherapy followed by total cystectomy. Data were complete on each patient until the end of 1985 (minimum follow-up 3 years, median 5.6), when 48 patients were alive without evidence of bladder cancer and 28 had died of intercurrent illness (without clinical evidence of bladder cancer). The overall actuarial 5-year survival rate (death from any cause) was 24%. The 5-year survival rates were 13% for group 1, 25% for group 2 and 38% for group 3. Group 1 patients had a significantly shorter survival. The difference between groups 2 and 3 was not statistically significant. The prognostic factors of significance for survival were clinical stage and ureteric obstruction. Factors such as age, tumour grade and multiplicity were significant when examined singly but not in a multivariate analysis which included stage and ureteric obstruction. The actuarial incidence of all radiotherapy complications in bladder and bowel was 9.4 and 10.5% respectively.