Survival after curative treatment of muscle-invasive bladder cancer.

This retrospective study includes 534 patients who had curatively intended treatment for T2/T3/T4a bladder cancer at the Norwegian Radium Hospital during the period 1980-1990. Total cystectomy preceded by preoperative radiotherapy represented the treatment of choice in 263 patients (CysGr). High-dose radiotherapy was applied in 271 patients in whom total cystectomy could not be performed (RadGr). From 1985 neo-adjuvant cisplatin-based chemotherapy was increasingly used. The 5-year crude survival rate for all patients was 35% with 40% for CysGr and 22% for RadGr. In CysGr the 5-year survival rate was highest (63%) for patients with <pT2 and lowest for pN+ patients (13%). The following independent prognostic parameters were identified for the total group: T category, trial participation, treatment, creatinine, haemoglobin, age and time since initial diagnosis. No significant difference in survival was found when comparing the treatment results obtained before and after 1985. In spite of the introduction of multimodality therapy the treatment results for T2/T3/T4a bladder cancer have remained unchanged. However, subgroups of patients may benefit from this approach allowing bladder conservation in selected cases. More effective adjuvant regimens have to be developed for high-risk patients (pT3b/pN+).