title: Brachytherapy versus cystectomy in solitary bladder cancer: a case control, multicentre, East-Netherlands study.
abstract: OBJECTIVE
  Comparing the outcome of surgery and brachytherapy-based radiotherapy in patients with solitary T1G3/T2 bladder tumour in, a retrospective case-control study, because efforts for a randomised clinical trial comparing these modalities have failed.
  
  
  METHODS
  Cystectomy group. Patients were selected using the pathological registration system (PALGA). 289 cases of TURT followed by cystectomy, indicated by a muscle--invading bladder tumour were performed in three East-Netherlands medical centres between 1991 and 2001. Out of this group 179 patients with clinical T2N0M0 bladder tumour were selected. All the consecutive files were analysed by a urologist and a radiation oncologist and 65 of those patients (mean age 63.7 years) would have been eligible for brachytherapy, based on an initial analysis: cystoscopy estimated tumour size, post-TURT pathological report, completed by CT-scan and/or, MRI-scan. A final pathological report after radical cystectomy was not considered for patients' selection. Brachytherapy group. Patients were selected using a prospective registration study aiming at determination of our treatment results. 89 Patients (mean age 68.4 years) underwent TURT followed by a course of external beam irradiation and interstitial brachytherapy from 1983 till 2005 in the Arnhem Radiotherapy Institute.
  
  
  RESULTS
  The median follow-up for the brachytherapy group was 5.7 years (range 0.2-21.4 years), for the cystectomy group was 5.05 years (range: 0.04-16.8 years). No difference in disease-specific survival (DSS) could be detected with a 5- and 10-year DSS of 71% and 66% in the brachytherapy group and 60% and 57% in the cystectomy group, respectively. Five-year overall survival (OS) was 57% in the brachytherapy group and 52% in the cystectomy group, however, the 10-year OS was better in the cystectomy than in the brachytherapy group (42% and 33%, respectively). This is caused by the significant age difference in favour of the cystectomy group. Cystectomy-free survival in the brachytherapy group was 70%.
  
  
  CONCLUSIONS
  Radical cystectomy is the treatment of choice for patients with muscle-invasive bladder carcinoma. However, in a selected patient population a bladder sparing treatment, i.e. a combination of transurethral tumour resection (TURT), external beam irradiation and interstitial brachytherapy, can be applied successfully. This concerns a solitary, T1G3 or T2 bladder tumour, with a diameter<5 cm.
authors.affiliation: ARTI Institute for Radiation Oncology Arnhem, The Netherlands. E.vandersteen@arnhemrti.nl
authors.forename: Elzbieta
authors.initials: E
authors.lastname: van der Steen-Banasik
authors.forename: Martine
authors.initials: M
authors.lastname: Ploeg
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Witjes
authors.forename: Farida S
authors.initials: FS
authors.lastname: van Rey
authors.forename: Jan G
authors.initials: JG
authors.lastname: Idema
authors.forename: Robert P
authors.initials: RP
authors.lastname: Heijbroek
authors.forename: Herbert F
authors.initials: HF
authors.lastname: Karthaus
authors.forename: Janny G
authors.initials: JG
authors.lastname: Reinders
authors.forename: A
authors.initials: A
authors.lastname: Viddeleer
authors.forename: Andries G
authors.initials: AG
authors.lastname: Visser
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D016022:Case-Control Studies; D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*