External beam radiation therapy followed by interstitial radiotherapy with iridium-192 for solitary bladder tumours: results of 111 treated patients.
BACKGROUND
Evaluation of bladder-preserving treatment protocol.


OBJECTIVE
To evaluate the long-term results of iridium-192 brachytherapy-based bladder-sparing treatment strategy in patients with solitary invasive bladder tumours.


METHODS
We performed a retrospective analysis of 111 patients with solitary T1G3-T2Gall bladder tumours (< or = 5 cm), who were treated with iridium-afterloading brachytherapy between February 1988 and May 2007.


METHODS
After transurethral tumour resection, external beam radiotherapy (28 Gy; 12 fractions) was given, followed by brachytherapy (Iridium-192; 40 Gy). Partial cystectomy was part of the treatment strategy in nine patients. In five of those patients a T3 tumour was found, and they were included in the analysis.


METHODS
The 5-, 10- and 15-yr overall survival rate (OS); disease-specific survival rate (DSS); and disease-free survival rate (DFS) estimates were determined using the Kaplan-Meier method.


CONCLUSIONS
Mean follow-up period was 6.2 yr (range: 0.2-16.3 yr). At the last follow-up 75 patients were alive without evidence of disease, whereas 17 patients had died without evidence of disease. Nineteen patients died of bladder cancer after a mean follow-up period of 2.9 yr (range: 0.5-9.0). OS rates at 5 yr, 10 yr, and 15 yr were 70%, 55%, and 51%, respectively. DSS rates at 5 yr, 10 yr, and 15 yr were 82%, 73% and 73%, respectively. DFS rates at 5 yr, 10 yr, and 15 yr were 60%, 47%, and 23%, respectively. Higher tumour stage (T3 vs T1) was negatively associated with DSS (hazard ratio [HR]:19.8; p=0.01) and DFS (HR: 4.67; p=0.02). No prognostic factor was found for OS. Local recurrence occurred in 27% of patients and salvage cystectomy was performed in 9% of patients. Bladder function was able to be preserved in 99 of 111 patients (89%).


CONCLUSIONS
In patients with solitary stage T1-T2 bladder cancer (< or = 5 cm) who refuse radical cystectomy or who are poor candidates for major surgical procedures, this modality is a valuable treatment alternative.
van Onna
Ilze E W
IE
Department of Urology, University Medical Center Utrecht, The Netherlands.
Oddens
Jorg R
JR
Kok
Esther T
ET
van Moorselaar
R Jeroen A
RJ
Bosch
J L H Ruud
JL
Battermann
Jan J
JJ
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D045823:Ileus / Q000209:etiology; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D053202:Urinary Incontinence, Urge / Q000209:etiology
D007496:Iridium Radioisotopes