Brachytherapy versus cystectomy in solitary bladder cancer: A case control, multicentre, East-Netherlands study

• Published in: Radiotherapy and oncology Vol. 93; no. 2; pp. 352 - 357
• Main Authors: van der Steen-Banasik, Elzbieta, Ploeg, Martine, Witjes, Johannes A, van Rey, Farida S, Idema, Jan G, Heijbroek, Robert P, Karthaus, Herbert F, Reinders, Janny G, Viddeleer, A, Visser, Andries G
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.11.2009
• Subjects: Aged; Bladder cancer; Brachytherapy; Brachytherapy - adverse effects; Case-Control Studies; Cystectomy; Cystectomy - adverse effects; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Retrospective Studies; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - radiotherapy; Urinary Bladder Neoplasms - surgery; Bladder cancer; Cystectomy; Brachytherapy
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2009.04.020

Abstract Purpose Comparing the outcome of surgery and brachytherapy-based radiotherapy in patients with solitary T1G3/T2 bladder tumour in, a retrospective case-control study, because efforts for a randomised clinical trial comparing these modalities have failed. Materials and methods Cystectomy group. Patients were selected using the pathological registration system (PALGA). 289 cases of TURT followed by cystectomy, indicated by a muscle – invading bladder tumour were performed in three East-Netherlands medical centres between 1991 and 2001. Out of this group 179 patients with clinical T2N0M0 bladder tumour were selected. All the consecutive files were analysed by a urologist and a radiation oncologist and 65 of those patients (mean age 63.7 years) would have been eligible for brachytherapy, based on an initial analysis: cystoscopy estimated tumour size, post-TURT pathological report, completed by CT-scan and/or, MRI-scan. A final pathological report after radical cystectomy was not considered for patients’ selection. Brachytherapy group. Patients were selected using a prospective registration study aiming at determination of our treatment results. 89 Patients (mean age 68.4 years) underwent TURT followed by a course of external beam irradiation and interstitial brachytherapy from 1983 till 2005 in the Arnhem Radiotherapy Institute. Results The median follow-up for the brachytherapy group was 5.7 years (range 0.2–21.4 years), for the cystectomy group was 5.05 years (range: 0.04–16.8 years). No difference in disease-specific survival (DSS) could be detected with a 5- and 10-year DSS of 71% and 66% in the brachytherapy group and 60% and 57% in the cystectomy group, respectively. Five-year overall survival (OS) was 57% in the brachytherapy group and 52% in the cystectomy group, however, the 10-year OS was better in the cystectomy than in the brachytherapy group (42% and 33%, respectively). This is caused by the significant age difference in favour of the cystectomy group. Cystectomy-free survival in the brachytherapy group was 70%. Conclusion Radical cystectomy is the treatment of choice for patients with muscle-invasive bladder carcinoma. However, in a selected patient population a bladder sparing treatment, i.e. a combination of transurethral tumour resection (TURT), external beam irradiation and interstitial brachytherapy, can be applied successfully. This concerns a solitary, T1G3 or T2 bladder tumour, with a diameter < 5 cm.