title: Conservative surgery plus brachytherapy treatment for boys with prostate and/or bladder neck rhabdomyosarcoma: a single team experience.
abstract: OBJECTIVE
  The aim of this study is to report the results of a conservative surgery + brachytherapy treatment for boys with prostate and/or bladder-neck rhabdomyosarcoma avoiding total cystectomy or prostatectomy and external radiotherapy.
  
  
  METHODS
  From 1991 to 2007, 26 boys were operated for a residual mass after chemotherapy (1 for local relapse). All patients underwent a conservative surgical procedure, with bladder-neck and urethra preservation. Surgery was never microscopically complete. Brachytherapy was systematically performed after tumor resection, as a perioperative procedure, consisting of 2 loops encompassing the prostate and the bladder-neck area. A dose of 60 Gy was delivered with low dose rate. Bladder function was evaluated clinically and with urodynamic study for boys with abnormal continence.
  
  
  RESULTS
  Median age at operation was 23 months (9 months-11 years). Seventeen boys underwent a partial prostatectomy associated in 5 with a partial cystectomy. The remaining 9 patients underwent a partial cystectomy with no procedure at the level of the prostate. At a median follow-up of 4 years (10 months-14.5 years), 24 of 26 boys are alive. Only 1 patient relapsed locally out of the brachytherapy field and died. A second boy died from metastatic relapse. Only 1 patient with bladder dysfunction after treatment underwent a total cystectomy. Four patients are too young to be evaluated for bladder function (<4 years of age). Seven patients, aged 4 to 6 years, have daytime continence, 1 has diurnal dribbling. Among 11 boys older than 6 years, 9 (82%) are normally continent (3 after temporary dribbling), 2 have diurnal dribbling treated by bladder education.
  
  
  CONCLUSIONS
  Even if very long-term sequelae of brachytherapy cannot be evaluated, this conservative combined treatment may allow normal continence in nearly all patients, even after temporary diurnal incontinence and should be discussed as an alternative to external radiotherapy or radical surgery.
authors.affiliation: Department of Pediatric Surgery, Le Kremlin-Bicêtre, France. helene.martelli@bct.aphp.fr
authors.forename: Hélène
authors.initials: H
authors.lastname: Martelli
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: Sophie
authors.initials: S
authors.lastname: Branchereau
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Franchi-Abella
authors.forename: Maria-Rosa
authors.initials: MR
authors.lastname: Ghigna
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dumas
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bouvet
authors.forename: Odile
authors.initials: O
authors.lastname: Oberlin
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D018365:Neoplasm, Residual / Q000532:radiotherapy / Q000601:surgery; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D012208:Rhabdomyosarcoma / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy* / Q000601:surgery