Bladder-conserving surgery and interstitial brachytherapy for lymph node negative transitional cell carcinoma of the urinary bladder: results of a 28-year single institution experience

• Published in: Radiotherapy and oncology Vol. 72; no. 2; pp. 147 - 157
• Main Authors: de Crevoisier, Renaud, Ammor, Aziz, Court, Bernard, Wibault, Pierre, Chirat, Erick, Fizazi, Karim, Theodore, Christine, Yom, Sue Sun, Haie-Meder, Christine
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.08.2004
• Subjects: Aged; Bladder cancer; Brachytherapy; Carcinoma, Transitional Cell - radiotherapy; Carcinoma, Transitional Cell - surgery; Cystectomy - methods; Disease-Free Survival; Female; Humans; Male; Middle Aged; Organ preservation; Radiotherapy Dosage; Radiotherapy, Adjuvant; Retrospective Studies; Treatment Outcome; Urinary Bladder Neoplasms - radiotherapy; Urinary Bladder Neoplasms - surgery; Bladder cancer; Brachytherapy; Organ preservation
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2004.06.002

We retrospectively analyzed results for lymph node negative transitional cell carcinoma of the bladder treated with brachytherapy. From 1975–2002, 58 patients received preoperative external irradiation, partial cystectomy (in 69%), iliac node dissection, and iridium-192. Pathologic stage was: 10 pT1, 41 pT2, and 7 pT3. A median total brachytherapy dose of 60 Gy was delivered to the tumor bed. Mean follow-up was 76 months (range, 0.5–296). Tumor stage significantly impacted cause-specific and disease-free survival ( P=0.02). Eight pT1 patients were free of disease and 2 died of other cause. For pT2 patients, 5-year cause-specific and overall survival rates were, respectively, 70% (CI 95%: 53–87) and 60% (CI 95%: 43–77). Three pT3 patients died of cancer. For the pT2 patients, the probability of 5-year local control was 65% (CI 95%: 47–83) and being alive without disease with a functional bladder, 50% (CI 95%: 33–67). Previous transurethral resection (TUR) increased the bladder relapse risk among pT2 patients ( P=0.03). Twelve patients had severe acute complications and 5 had severe late effects. A high dose of external irradiation increased risk of late complications ( P=0.01). Most complications occurred in patients treated before 1985. Highly select patients presenting with pT2 tumors less than 5 cm with no history of previous TUR may be successfully treated with low-dose external irradiation, limited partial cystectomy, and interstitial brachytherapy. High-risk pT1 patients may also benefit. Postoperative complications and late side effects are minimized with modern management. We recommend lifelong cystoscopic surveillance, with prompt surgical salvage for recurrence.