title: Radiochemotherapy after transurethral resection for high-risk T1 bladder cancer: an alternative to intravesical therapy or early cystectomy?
abstract: OBJECTIVE
  For high-risk T1 bladder cancer, the most important issue is how to restrict radical cystectomy to selective patients with a high likelihood of tumor progression and to choose an initial bladder-sparing approach in others without affecting survival. Radiotherapy or radiochemotherapy (RT/RCT) may help to strike a balance between intravesical treatment and early cystectomy.
  
  
  METHODS
  Between 1982 and 2004, 141 patients with high-risk T1 bladder cancer (84 patients with T1 grade 3 [T1G3]; others with T1G1/2 and associated carcinoma-in-situ, multifocality, tumor diameter > 5 cm, or multiple recurrences) were treated with RT (n = 28) or platinum-based RCT (n = 113) after transurethral resection of bladder tumor (TURBT). Six weeks after RT/RCT, response was evaluated by restaging TURBT. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response (CR). Median follow-up was 62 months; 65 patients have been observed for 5 years or more.
  
  
  RESULTS
  CR was achieved in 121 of 137 patients (88%; four patients without restaging TURBT). Tumor progression for the entire group of 141 patients was 19% and 30% at 5 and 10 years, respectively (for 121 patients with CR, 15% and 29%; for 84 patients with T1G3, 13% and 29%, respectively). Disease-specific survival rates were 82% and 73% at 5 and 10 years (CR, 89% and 79%; T1G3, 80% and 71%, respectively). More than 80% of survivors preserved their bladder; 70.4% were "delighted" or "pleased" with their urinary function.
  
  
  CONCLUSIONS
  RT/RCT after TURBT with selective bladder preservation is a reasonable alternative to intravesical treatment or early cystectomy for high-risk T1 bladder cancer.
authors.affiliation: Department of Radiation Therapy, University of Erlangen, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Weiss
authors.forename: Carolin
authors.initials: C
authors.lastname: Wolze
authors.forename: Dirk Gerhard
authors.initials: DG
authors.lastname: Engehausen
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Ott
authors.forename: Frens S
authors.initials: FS
authors.lastname: Krause
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Schrott
authors.forename: Jürgen
authors.initials: J
authors.lastname: Dunst
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
authors.forename: Claus
authors.initials: C
authors.lastname: Rödel
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D015653:Cystectomy; D003558:Cystoscopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011878:Radiotherapy; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents