title: Management of superficial recurrences in an irradiated bladder after combined-modality organ-preserving therapy.
abstract: OBJECTIVE
  Standard treatment for superficial bladder cancer is transurethral resection of the bladder tumor (TURBT) followed by intravesical therapy. Little is known about the biologic behavior and treatment response of superficial disease within an irradiated bladder. We specifically analyzed patients who developed superficial recurrence after TURBT and radiotherapy or radiochemotherapy.
  
  
  METHODS
  Between 1982 and 2006, a total of 531 consecutive patients with invasive bladder cancer were treated by using various bladder-sparing protocols at our institution. Of these, 389 (76%) achieved a complete response after TURBT and radiotherapy/radiochemotherapy. During follow-up, 68 of 389 patients (17%) developed a superficial local relapse (< or = T1) and form the subject of this study.
  
  
  RESULTS
  Sixty-four of 68 patients underwent conservative TURBT with or without intravesical treatment (4 patients underwent immediate cystectomy): 31 of 64 patients (48%) had no further bladder recurrence, 21 (33%) experienced additional superficial recurrences, and 12 (19%) ultimately progressed to muscle-invasive disease. Disease-specific survival rates were 87% and 72% at 5 and 10 years, respectively. Compared with 255 patients without local bladder relapse after primary treatment, no significant difference was found for disease-specific survival rates (72% after superficial vs. 79% without local relapse at 10 years, p = 0.78). However, significantly fewer patients with a superficial relapse survived with their native bladder (50% after superficial vs. 76% without local relapse at 10 years, p < 0.001).
  
  
  CONCLUSIONS
  A further bladder-sparing approach with TURBT and intravesical therapy is reasonable for patients with superficial relapse after combined-modality treatment without compromising survival. However, these patients are at greater risk of requiring late cystectomy.
authors.affiliation: Department of Radiation Therapy, University of Erlangen, Erlangen, Germany. weisserlangen@web.de
authors.forename: Christian
authors.initials: C
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Wittlinger
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Engehausen
authors.forename: Frens S
authors.initials: FS
authors.lastname: Krause
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Ott
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: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002985:Clinical Protocols; D003131:Combined Modality Therapy / Q000379:methods; D015653:Cystectomy / Q000379:methods; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000528:radiation effects / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*