Treatment of Carcinoma of the Bladder With Combined Radiotherapy, Chemotherapy, and Surgery

The treatment of invasive and rapidly recurring bladder tumors is a perennial challenge confronting urologists. Surgery and radiation have salvaged some patients but the majority of individuals have gone on to suffer the cruel denouement of their disease. During the last decade our interest has been piqued and our hopes raised by the development of improved surgical techniques, high energy radiation equipment, and cancer chemotherapy. It is now clear, however, that operations, even with pelvic node dissection and ureteroileocutaneous urinary diversions, "cure" fewer than 30% of patients with deeply invasive bladder cancer and only about half of the patients who have less aggressive tumors. Likewise, megavoltage radiotherapy alone may salvage a certain percentage of patients with locally invasive bladder tumors, but the majority (60% to 70%) of such patients derive no benefit. Of the drugs which have been employed, thiotepa has been effective in curing or preventing recurrence of superficial