The Heterogeneity of Invasive Bladder Carcinoma and Different Responses to Treatment

Abstract

No AccessJournal of Urology1 May 1980The Heterogeneity of Invasive Bladder Carcinoma and Different Responses to Treatment Nelson H. Slack and George R. Prout Nelson H. SlackNelson H. Slack More articles by this author and George R. ProutGeorge R. Prout More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)56075-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail We studied 475 patients with carcinoma of the bladder to test the effect of adjuvant radiotherapy (4,500R in 28 to 32 days) on the surgical management of patients with histological proof of muscle invasion. The patients were randomized to receive radiotherapy or not and then an appropriate open operation (more than 85 per cent cystectomy). While all patients never completed the protocol of those who did it was almost immediately evident that radiotherapy resulted in apparent destruction of the tumor as determined by pathological examination in a third of the surgical specimens (Po). For several years no advantage to the radiotherapy group was evident but subsequent followup revealed that the Po group was surviving significantly better than the control group. The current analysis, while lacking complete data on all patients, indicates that invasive bladder carcinoma usually is solid and that solid tumors most commonly invade lymphatics and are not radiosensitive. Invasive papillary carcinomas are more commonly radiosensitive and do not invade lymphatics as frequently as solid tumors. Patients with papillary invasive carcinoma who have no lymphatic involvement in the transurethral resection specimen, receive radiotherapy and are Po have a probability of surviving 5 years in excess of 85 per cent, while patients with solid tumor and lymphatic invasion who receive radiotherapy and are P+ have a 20 per cent probability of surviving 5 years. Invasive bladder carcinomas are exceedingly heterogeneous and examination of the transurethrally resected specimen and the cystectomy specimen provides valuable information concerning the probability of survival. These data provide the basis for testing this hypothesis and for developing therapeutic strategies based on prognostic indicators. © 1980 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLEISSNER J, KOEPPEN C and WOLF H (2018) Prognostic Significance of Vascular and Perineural Invasion in Urothelial Bladder Cancer Treated With Radical CystectomyJournal of Urology, VOL. 169, NO. 3, (955-960), Online publication date: 1-Mar-2003.Droller M (2018) PRINCIPLES OF ONCOLOGY AND IMMUNOLOGY, AND TUMORS OF BLADDER, PENIS AND URETHRAJournal of Urology, VOL. 163, NO. 2, (660-667), Online publication date: 1-Feb-2000.Prout G, Shipley W, Kaufman D, Heney N, Griffin P, Althausen A, Bassil B, Nocks B, Parkhurst E and Young H (2018) Preliminary Results in Invasive Bladder Cancer with Transurethral Resection, Neoadjuvant Chemotherapy and Combined Pelvic Irradiation Plus Cisplatin ChemotherapyJournal of Urology, VOL. 144, NO. 5, (1128-1134), Online publication date: 1-Nov-1990.Scher H, Yagoda A, Herr H, Sternberg C, Bosl G, Morse M, Sogani P, Watson R, Dershaw D, Reuter V, Geller N, Hollander P, Vaughan E, Whitmore W and Fair W (2018) Neoadjuvant M-Vac (Methotrexate, Vinblastine, Doxorubicin and Cisplatin) Effect on the Primary Bladder LesionJournal of Urology, VOL. 139, NO. 3, (470-474), Online publication date: 1-Mar-1988.Shipley W, Rose M, Perrone T, Mannix C, Heney N and Prout G (2018) Full-Dose Irradiation for Patients with Invasive Bladder Carcinoma: Clinical and Histological Factors Prognostic of Improved SurvivalJournal of Urology, VOL. 134, NO. 4, (679-683), Online publication date: 1-Oct-1985.Raghavan D, Pearson B, Duval P, Rogers J, Meagher M, Wines R, Mameghan H, Boulas J and Green D (2018) Initial Intravenous Cis-Platinum Therapy: Improved Management for Invasive High Risk Bladder Cancer?Journal of Urology, VOL. 133, NO. 3, (399-402), Online publication date: 1-Mar-1985.Droller M (2018) Editorial CommentsJournal of Urology, VOL. 132, NO. 4, (676-677), Online publication date: 1-Oct-1984.Heney N, Proppe K, Prout G, Griffin P and Shipley W (2018) Invasive Bladder Cancer: Tumor Configuration, Lymphatic Invasion and SurvivalJournal of Urology, VOL. 130, NO. 5, (895-897), Online publication date: 1-Nov-1983.Droller M (2018) Editorial CommentJournal of Urology, VOL. 124, NO. 1, (45-45), Online publication date: 1-Jul-1980. Volume 123Issue 5May 1980Page: 644-652 Advertisement Copyright & Permissions© 1980 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Nelson H. Slack More articles by this author George R. Prout More articles by this author Expand All Advertisement PDF downloadLoading ...