THE MANAGEMENT OF INVASIVE BLADDER CANCER: A REVIEW OF SELECTED AUSTRALASIAN STUDIES IN RADIOTHERAPY, CHEMOTHERAPY AND CYSTECTOMY

Abstract

Since 1968, studies have been conducted in Australia and New Zealand to improve the results of treatment for invasive bladder cancer. The prognostic value of clinical stage and of ureteric obstruction has been confirmed. Radiotherapy has been established as appropriate treatment for the majority of patients with bladder cancer, most of whom are elderly and suffer from other health problems. There has been no additional benefit from radiosensitizers in increasing the effectiveness of radiotherapy such as hyperbaric oxygen or misonidazole, or from irradiation of the para-aortic nodes, all of which can result in additional toxicity without increasing tumour control. Pre-emptive chemotherapy with cisplatin has had no obvious impact on improving survival. Elective total cystectomy has shown the prognostic value of tumour downstaging by pre-operative pelvic radiotherapy. Although younger patients are usually selected for total cystectomy and urinary diversion, there is no evidence that, stage for stage, elective total cystectomy confers a survival advantage compared with radical pelvic radiotherapy.