Radiotherapy with and without cisplatin in bladder cancer

From October 1985 to December 1988,67 patients with invasive bladder carcinoma T_1-4 N_0-2M₀ were treated with irradiation (50.4 Gy in 28 fractions in 6 weeks) and simultaneous cisplatin (25 mg/m² per day on 5 consecutive days in the first and fifth irradiation week). After transurethral resection and irradiation plus cisplatin, complete remissions were achieved in 8 11 T₁-, 14 16 T₂-, 27 36 T₃- and 1 4 T₄-tumors. The complete remission rate 6 weeks after treatment according to the extent of preceeding transurethral surgery (TUR) was: R₀: 67% ( 8 12); R₁: 83% ( 20 24); R₂: 70% ( 21 30); R_x: 1 1. In patients with incomplete TUR (R_1-2), the complete remission rate was 76% ( 41 54). This was superior to the results of a historical control (76% vs. 45%, p < 0.01). The estimated 3-year survival according to T-stage was: T₁: 73%, T_2-3: 68%, T₄: 25%. The overall 3-year survival was unchanged as compared to our historical control (66% each). Severe complications have not been observed. We conclude that cisplatin will likely increase the local control rate after incomplete transurethral surgery. An improvement of survival seems unlikely.