CLINICAL INVESTIGATION Bladder
SIMILAR TREATMENT OUTCOMES FOR RADICAL CYSTECTOMY AND
RADICAL RADIOTHERAPY IN INVASIVE BLADDER CANCER TREATED
AT A UNITED KINGDOM SPECIALIST TREATMENT CENTER
, M.S., M.R.C.S.,
, M.A., M.R.C.P., F.R.C.R.,
, M.D., F.R.C.S. E
, M.S., F.R.C.S.,
, D.M., M.R.C.P. (UK)., F.R.C.R.
*Pyrah Department of Urology, St. James’s University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom;
Cancer Research UK Clinical Centre, Section of Oncology, Leeds Institute of Molecular Medicine, Leeds, United Kingdom; and
Cancer Research UK Clinical Centre, Section of Oncology, St. James’s University Hospital, Leeds, United Kingdom
Purpose: To conduct a retrospective analysis within a large university teaching hospital, comparing outcomes
between patients receiving either radical surgery or radiotherapy as curative treatment for bladder cancer.
Patients and Methods: Between March 1996 and December 2000, 169 patients were treated radically for muscle-
invasive bladder cancer. Data were collected from patient notes. Statistical analyses were performed using Kaplan-
Meier methods and Cox proportional hazards regression analysis to compare radiotherapy and surgical outcome
Results: There was no difference in overall, cause-speciﬁc, and distant recurrence-free survival at 5 years between
the two groups, despite the radiotherapy group being older (median age, 75.3 years vs. 68.2 years). There were 31
local bladder recurrences in the radiotherapy group (24 solitary), but there was no signiﬁcant difference in distant
recurrence-free survival. In a more recent (2002–2006) cohort, the median age of radiotherapy patients but not the
cystectomy patients was higher than in the 1996–2000 cohort (78.4 years vs. 75.3 years for radiotherapy and 67.9
years vs. 68.2 years for surgery).
Conclusions: Although the patients undergoing radical cystectomy were signiﬁcantly younger than the radiother-
apy patients, treatment modality did not inﬂuence survival. Bladder cancer patients are an increasingly elderly
group. Radical radiotherapy is a viable treatment option for these patients, with the advantage of organ preserva-
tion. Ó 2008 Elsevier Inc.
Bladder cancer, Radical cystectomy, Radiotherapy, Treatment comparison, Cause-speciﬁc survival.
Bladder cancer is the ﬁfth most common cancer in the United
Kingdom (UK), with 10,200 people diagnosed and 4800
deaths per year (1). Curative treatment options for invasive
transitional cell carcinoma include radical cystectomy and
radical radiotherapy. In North America, cystectomy is the tra-
ditional treatment approach and provides good local tumor
control (2–4). However, in the United States in the past 2
decades there has been increasing interest in a multimodality
approach to bladder cancer treatment with organ preservation
(5, 6), with cystectomy reserved for salvage, a practice prev-
alent in Europe for many years. Ro¨del et al. (7) showed that
transurethral resection of the bladder tumor (TURBT) with
radiotherapy or chemoradiotherapy is a reasonable alterna-
tive to cystectomy, with 10 year cause-speciﬁc survival
(CSS) rates of 42% and with 80% of patients preserving their
Furthermore, early and late morbidity after a radical cys-
tectomy can be problematic and can include risks of hemor-
rhage, infection, urinary leaks, pelvic lymphoceles, intestinal
obstruction, and peritonitis (8, 9). Even the construction of
Reprint requests to: Anne E. Kiltie, D.M., M.R.C.P. (UK).,
F.R.C.R., Cancer Research UK Clinical Centre, Section of Oncol-
ogy, Leeds Institute of Molecular Medicine, Beckett Street, Leeds
LS9 7TF, United Kingdom. Tel: (+44) 113-3438412; Fax: (+44)
113-2429886; E-mail: firstname.lastname@example.org
A.E.K. and A.C. are funded by Cancer Research UK.
Presented in poster form at the UK Radiation Oncology confer-
ence, April 7–9, 2003, Bath, United Kingdom. The 2002–2006
cohort of radiotherapy patients was presented in part by P.W. as
part of a debate at the European Association of Urologists meeting,
April 5–8 2006, Paris, France.
Conﬂict of interest: none.
Acknowledgments—The authors thank Mr. J. Cartledge, Mr. I.
Eardley, Mr. A. Joyce, Mr. S.N. Lloyd, Dr. W.G. Jones, and
Mr. S. Prescott for permission to review their patients’ records;
Dr. F.U. Chowdhury for reviewing the imaging results for a few
patients; and the Northern and Yorkshire Cancer Registry and
Information Service for data on cause of death for a few patients.
Received Feb 27, 2007, and in revised form June 6, 2007.
Accepted for publication June 20, 2007.
Int. J. Radiation Oncology Biol. Phys., Vol. 70, No. 2, pp. 456–463, 2008
Copyright Ó 2008 Elsevier Inc.
Printed in the USA. All rights reserved
0360-3016/08/$–see front matter