Carcinoma of the Bladder: Cystectomy after Supervoltage Therapy

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Abstract
For 10 years we have treated carcinoma of the bladder with external Cobalt 60 irradiation. In cases where the tumour was still viable 6 months after irradiation or showed a later recurrence, further treatment by cystectomy and urinary diversion is discussed. Out of 450 irradiated patients 35 were selected for complementary cystectomy and urinary diversion after irradiation. Six patients died of postoperative complications. Seven patients recovered uneventfully from surgery. The remainder had various severe complications. Fifteen patients died within 1 year of the operation. At follow-up, 9 patients are still living. The pathologic anatomic specimens were graded according to malignancy of cell type and depth of growth. A significant correlation between histological grading and survival time was observed. Furthermore, a tendency towards short survival time was observed in cases where the tumour was penetrating the muscle. The result of the present study have given us the impression that late surgery after irradiation of poorly differentiated tumours with growth in the muscle will not prolong the survival time and often will cause the patient unnecessary suffering.