[Role of the combination of external radiotherapy--partial cystectomy--interstitial brachytherapy in pT1 G3, pT2 and pT3 bladder tumors].
Although it is still the reference method for curative treatment of invasive bladder cancer, radical cystectomy is a major surgical procedure justifying the evaluation of surgical tumoral excision in combination with curietherapy. At Nice University Hospital, between 1986 and 1998, 29 men with invasive bladder cancer were treated by partial cystectomy and interstitial brachytherapy. All the patients received external preoperative radiation of the pelvis of 10.5 Gy (Three 3.5 Gy flashes) three days before partial cystectomy associated with implantation of curietherapy guides carried out on average Five days after surgery with the dose of 50 Gy. After between 5 to 17 years of follow-up, eight deaths out of 14 occurred due to the disease and/or treatment, three patients had a superficial recurrence and one patient underwent salvage prostatocystectomy. Curietherapy gave rise to no direct complications, three patients suffered an eventration and 1 evisceration. Two out of 15 surviving patients suffer from invalidating pollakiuria and one from chronic retention. This study shows that overall survival corrected for intercurrent deaths is lower than data in the literature, though the low sample size makes it impossible to compare the carcinological results and survival per pT category. In addition, this strategy results in fewer complications after radiation therapy. Hence, although a certain number of questions remain unanswered, it seems possible for suitably selected patients to expect the same cure rates as radical surgery with reduced morbidity.
Jordana
F
F
Fédération d'urologie néphrologie, hôpital Pasteur, BP 69, 06002 Nice, France.
Lagrange
J L
JL
Gérard
J P
JP
Amiel
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*