Brachytherapy after external beam radiotherapy and limited surgery preserves bladders for patients with solitary pT1-pT3 bladder tumors.
BACKGROUND
Several French, Belgian and Dutch radiation oncologists have reported good results with the combination of limited surgery after external beam radiotherapy (EBRT) followed by brachytherapy in early-stage muscle-invasive bladder cancer.


METHODS
Data from 12 of 13 departments which are using this approach have been collected retrospectively, in a multicenter database, resulting in 1040 patients: 811 males and 229 females with a median age of 66 years, range 28-92 years. Results were analyzed according to tumor stage and diameter, histology grade, age and brachytherapy technique, continuous low-dose rate (CLDR) and pulsed dose rate (PDR).


RESULTS
At 1, 3 and 5 years, the local recurrence-free probability was 91%, 80% and 75%, metastasis-free probability was 91%, 80% and 74%, disease-free probability was 85%, 68% and 61% and overall survival probability was 91%, 74% and 62%, respectively. The differences in the outcome between the contributing departments were small. After multivariate analysis, the only factor influencing the local control rate was the brachytherapy technique. Toxicity consisted mainly of 24 fistula, 144 ulcers/necroses and 93 other types.


CONCLUSIONS
EBRT followed by brachytherapy, combined with limited surgery, offers excellent results in terms of bladder sparing for selected groups of patients suffering from bladder cancer.
Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam. Electronic address: c.c.koning@amc.uva.nl.
C C E
CCE
Koning
Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
L E C M
LECM
Blank
Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
C
C
Koedooder
Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
R M
RM
van Os
Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
M
M
van de Kar
Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
E
E
Jansen
Departments of Radiation Oncology and Urology, University Medical Centre Utrecht, Utrecht.
J J
JJ
Battermann
Department of Radiation Oncology, University Medical Centre Groningen, Groningen.
M
M
Beijert
Department of Radiation Oncology, Medisch Spectrum Twente, Enschede.
C
C
Gernaat
TweeSteden Hospital, Department of Urology, Tilburg.
K A M
KAM
van Herpen
Radiotherapeutic Institute RISO, Department of Radiation Oncology, Deventer.
C
C
Hoekstra
The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Departments of Urology and Radiation Oncology, Amsterdam.
S
S
Horenblas
Department of Radiation Oncology, Medisch Spectrum Twente, Enschede.
J J
JJ
Jobsen
Department of Radiation Oncology, University Medical Centre Leiden, Leiden.
A D G
ADG
Krol
Department of Radiation Oncology, Catharina Hospital Eindhoven.
M L M
MLM
Lybeert
Amphia Hospital, Department of Urology, Breda.
I E W
IEW
van Onna
Department of Urology, University Medical Centre Leiden, Leiden.
R C M
RCM
Pelger
Institute Verbeeten, Department of Radiation Oncology, Tilburg.
P
P
Poortmans
The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Departments of Urology and Radiation Oncology, Amsterdam.
F J
FJ
Pos
Arnhem Radiotherapeutic Institute (ARTI), Arnhem.
E
E
van der Steen-Banasik
Radiotherapeutic Institute Friesland (RIF), Leeuwarden, The Netherlands.
A
A
Slot
Arnhem Radiotherapeutic Institute (ARTI), Arnhem.
A
A
Visser
Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
B R
BR
Pieters
D000230:Adenocarcinoma / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D002295:Carcinoma, Transitional Cell / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D015653:Cystectomy; D053715:Cystotomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy* / Q000601:surgery*