Not all patients are suitable for radiation treatment; those with inflammatory bowel disease, extensive previous pelvic surgery or chronic pelvic infections are better treated with surgery. Also, patients with severe irritable bladder symptoms frequently have intolerable distress during radiation and are better served by cystectomy, because treatment rarely results in useful bladder function. Patients treated with radical external beam radiation therapy must undergo careful follow-up with cystoscopy so that if there is not response to treatment or there is a recurrence , surgery (salvage cystectomy)can be performed promptly. Salvage cystectomy after full-dose external beam radiotherapy can be performed safely with only a slight increase in postoperative complications and is often curative. The long-term follow-up of patients treated with external beam radiation therapy shows that up to 25 percent can be cured and preserve normal bladder function. Whether immediate cystectomy or radiotherapy (with the option of cystectomy for salvage) gives a better chance of cure is unclear at present.
Chemotherapy When superficial tumors constantly recur, intravesical treatment is tried. This
therapy permits direct contact of high concentrations of cytotoxic or immunologic drugs in the bladder, which bathe the superficial cancer cells for one or two hours. People with renal pelvis, ureteral and urethral cancers are not good candidates for intravesical therapy, although some reports have described limited success.
There have been more studies of chemotherapy with single and combination drug regimens, before and/or after surgery or radiation therapy.
