Comment: Conservatism vs Radicalism in Treatment

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Abstract
The survival results in bladder cancer become poorer as the treatment becomes more radical. In Jewett's report, for stage A lesions, transurethral resection provides a 70% success rate, whereas total cystectomy provides only 50%. For stage Bl, there is little difference in survival with the more aggressive procedures (50% ± 5%). Examination of the radiation results offered by Friedman again illustrates that the more conservative method of treatment (radium as a central source) yields a three-year survival rate, which is distinctly superior to the rate with 2 mev x-ray irradiation therapy, 93% vs 62%, respectively. This observation was also found in the detailed analysis of the experience at the Royal Marsden Hospital in London.16 Although the figures clearly argue for conservatism in therapy, the truth lies in the unreported facts. The selection of one criterion, depth of penetration, is inadequate to make the patients in any series comparable. In

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