title: Combined intracavitary and external beam irradiation for superficial transitional cell carcinoma of the bladder: an alternative to cystectomy for patients with recurrence after intravesical chemotherapy.
abstract: A total of 17 patients with superficial transitional cell carcinoma of the bladder underwent treatment with pelvic external beam irradiation followed by an intracavitary 137cesium implant via a triple lumen Foley catheter. Of these patients 11 had recurrent and multifocal superficial cancer, with 8 having relapse after prior intravesical chemotherapy. External beam doses of 3,600 to 5,066 cGy. were followed by implant doses delivering 2,000 to 3,200 cGy. to the bladder mucosa, with the sum of external and intracavitary doses totaling 6,500 to 7,500 cGy. Of 15 patients evaluable with a median followup of 48 months, and including 13 followed for more than 2 years, 11 (73 per cent) remain free of disease, 3 (20 per cent) have recurrence in the bladder but have retained the bladder and only 1 has required cystectomy. All 4 failures occurred in the subgroup of 8 patients who had received prior intravesical chemotherapy. This bladder-sparing approach is well tolerated, is an alternative to cystectomy in patients with recurrent superficial transitional cell carcinoma of the bladder and in our series has salvaged 50 per cent (4 of 8) of the patients even after failure of intravesical chemotherapy.
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle.
authors.forename: K J
authors.initials: KJ
authors.lastname: Russell
authors.forename: W J
authors.initials: WJ
authors.lastname: Koh
authors.forename: A H
authors.initials: AH
authors.lastname: Russell
authors.forename: B R
authors.initials: BR
authors.lastname: Griffin
authors.forename: K L
authors.initials: KL
authors.lastname: Markette
authors.forename: D Y
authors.initials: DY
authors.lastname: Tong
authors.forename: T W
authors.initials: TW
authors.lastname: Griffin
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000532:radiotherapy*; D002588:Cesium Radioisotopes / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011882:Radiotherapy, High-Energy; D013852:Thiotepa / Q000008:administration & dosage; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*
chemical_list: D002588:Cesium Radioisotopes; D008937:Mitomycins; D016685:Mitomycin; D013852:Thiotepa