title: Saving bladders with brachytherapy: implantation technique and results.
abstract: OBJECTIVE
  To analyze and report the treatment results of brachytherapy for solitary bladder cancer in the Arnhem Radiotherapy Institute.
  
  
  METHODS
  Between January 1983 and October 1998, 63 patients with a solitary bladder tumor were treated with a combination of transurethral resection, external beam radiotherapy (EBRT), and interstitial radiotherapy. The indications for bladder-conserving treatment were tumor < or =5 cm, T1G3 (n = 14), T2G2 (n = 8), T2G3 (n = 37), and T3a (n = 4). The prescribed implant dose was either 55 Gy (range 50-65 Gy) in combination with small pelvis external beam RT, 3-4 fractions of 3.5 Gy (n = 58), or 30 Gy in combination with 20 fractions of 2 Gy external beam radiotherapy (n = 5). Brachytherapy was performed with 2-8 137Cs needles until 1995 (n = 48) and 2-5 afterloading catheters (192Ir) since 1996 (n = 15). Follow-up cystoscopies were performed at 3-month intervals during the first 2 years, then every 6 months for 3 years, and annually after the fifth year. The median follow-up was 4.9 years.
  
  
  RESULTS
  Twenty patients developed local recurrences, of which 6 were "true in-implant recurrences," 12 were in second bladder locations, and 2 were urethral recurrences. All recurrences developed within 2.5 years after treatment. Of these 20 patients, 13 underwent cystectomy: 6 stayed disease-free, 1 died of postoperative complications, 2 developed regional metastases, and 4 developed distant metastases. The 5-year disease-specific survival rate was 80% for patients with Stage T1 and 60% for those with Stage T2 disease. The local control rate was 70% in the whole patient population and 80% after salvage cystectomy. Forty-four bladders were saved. Acute complications were seen in 14 patients, and no significant late complications occurred.
  
  
  CONCLUSIONS
  Using this treatment technique, a high cure rate with conservation of the bladder and only minor toxicity can be obtained in a selected patient population having a solitary tumor < or =5 cm.
authors.affiliation: Joint Center for Radiation Oncology, Arnhem-Nijmegen, Radian-Arti, Wagnerlaan 47, 6815 AD Arnhem, The Netherlands. e.vandersteen@Radian.nl
authors.forename: Elzbieta M
authors.initials: EM
authors.lastname: Van der Steen-Banasik
authors.forename: Andries G
authors.initials: AG
authors.lastname: Visser
authors.forename: Janny G
authors.initials: JG
authors.lastname: Reinders
authors.forename: Robert P
authors.initials: RP
authors.lastname: Heijbroek
authors.forename: Jan G
authors.initials: JG
authors.lastname: Idema
authors.forename: Theodorus G
authors.initials: TG
authors.lastname: Janssen
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Leer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery