title: 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.
abstract: OBJECTIVE
  We retrospectively analyzed results for lymph node negative transitional cell carcinoma of the bladder treated with brachytherapy.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, Institut Gustave-Roussy, 94805 Villejuif, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: de Crevoisier
authors.forename: Aziz
authors.initials: A
authors.lastname: Ammor
authors.forename: Bernard
authors.initials: B
authors.lastname: Court
authors.forename: Pierre
authors.initials: P
authors.lastname: Wibault
authors.forename: Erick
authors.initials: E
authors.lastname: Chirat
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.forename: Christine
authors.initials: C
authors.lastname: Theodore
authors.forename: Sue Sun
authors.initials: SS
authors.lastname: Yom
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
mesh_terms: D000368:Aged; D001918:Brachytherapy; D002295:Carcinoma, Transitional Cell / Q000532:radiotherapy* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy* / Q000601:surgery*