title: Bladder function preservation with brachytherapy, external beam radiation therapy, and limited surgery in bladder cancer patients: Long-term results [corrected].
abstract: OBJECTIVE
  To report long-term results of a bladder preservation strategy for muscle-invasive bladder cancer (MIBC) using external beam radiation therapy and brachytherapy/interstitial radiation therapy (IRT).
  
  
  METHODS
  Between May 1989 and October 2011, 192 selected patients with MIBC were treated with a combined regimen of preoperative external beam radiation therapy and subsequent surgical exploration with or without partial cystectomy and insertion of source carrier tubes for afterloading IRT using low dose rate and pulsed dose rate. Data for oncologic and functional outcomes were prospectively collected. The primary endpoints were local recurrence-free survival (LRFS), bladder function preservation survival, and salvage cystectomy-free survival. The endpoints were constructed according to the Kaplan-Meier method.
  
  
  RESULTS
  The mean follow-up period was 105.5 months. The LRFS rate was 80% and 73% at 5 and 10 years, respectively. Salvage cystectomy-free survival at 5 and 10 years was 93% and 85%. The 5- and 10-year overall survival rates were 65% and 46%, whereas cancer-specific survival at 5 and 10 years was 75% and 67%. The distant metastases-free survival rate was 76% and 69% at 5 and 10 years. Multivariate analysis revealed no independent predictors of LRFS. Radiation Therapy Oncology Group grade ≥3 late bladder and rectum toxicity were recorded in 11 patients (5.7%) and 2 patients (1%), respectively.
  
  
  CONCLUSIONS
  A multimodality bladder-sparing regimen using IRT offers excellent long-term oncologic outcome in selected patients with MIBC. The late toxicity rate is low, and the majority of patients preserve their functional bladder.
authors.affiliation: Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands. Electronic address: s.aluwini@erasmusmc.nl.
authors.forename: Shafak
authors.initials: S
authors.lastname: Aluwini
authors.affiliation: Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands.
authors.forename: Peter H E
authors.initials: PH
authors.lastname: van Rooij
authors.affiliation: Department of Urology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands.
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Kirkels
authors.affiliation: Department of Urology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands.
authors.forename: Joost L
authors.initials: JL
authors.lastname: Boormans
authors.affiliation: Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands.
authors.forename: Inger-Karina K
authors.initials: IK
authors.lastname: Kolkman-Deurloo
authors.affiliation: Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands.
authors.forename: Arendjan
authors.initials: A
authors.lastname: Wijnmaalen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D015653:Cystectomy / Q000379:methods / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments / Q000379:methods* / Q000401:mortality; D058958:Organs at Risk / Q000528:radiation effects; D011446:Prospective Studies; D012007:Rectum / Q000528:radiation effects; D001743:Urinary Bladder / Q000528:radiation effects / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*