ADVANCED CANCER OF THE URINARY BLADDER

AN ANALYSIS OF THE RESULTS OF RADIOTHERAPY ALONE vs. RADIOTHERAPY AND CONCOMITANT 5-FLUOROURACIL; A PROSPECTIVE RANDOMIZED STUDY OF 36 CASES

During the period March 1962 through December 1966, 36 patients were entered into a prospectively randomized study to evaluate the effects of concomitant 5-FU therapy upon the radical supervoltage radiotherapy of advanced invasive carcinoma of the urinary bladder.

Despite the almost uniform transient increase in acute morbidity with the combined therapy technique employed in this study, no significant increase in long-term morbidity was encountered over those patients receiving only radical supervoltage radiotherapy.

This certainly would be an acceptable price to pay if indeed survival figures were enhanced by these techniques. However, despite the apparent reduction in demonstrable distant metastases utilizing the techniques of drug administration previously outlined, the results of this study, while fully comparable with other surgical series, although preserving bladder function, do not indicate any significant improvement in over-all patient survival when concomitant 5-FU is added to full-dose radical supervoltage radiotherapy in the management of patients with deeply invasive carcinoma of the urinary bladder.

It may well be, as the preliminary reports of Kaufman and Stein^12,16 tend to indicate, that the best use of 5-FU and supervoltage radiotherapy as a combined approach would be as pre-planned, midrange preoperative treatment. This would take into account both the high incidence of local treatment failures with either treatment regimen randomized in this present study as well as the apparent reduction of demonstrable distant metastases in the group receiving combined therapy. Hopefully, a prospectively randomized study can be devised to properly evaluate this approach.

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