title: Radical Cystectomy for Bladder Cancer in Patients With and Without a History of Pelvic Irradiation: Survival Outcomes and Diversion-related Complications.
abstract: OBJECTIVE
  To compare survival outcomes and diversion-related complications of patients with and without a history of pelvic irradiation who underwent radical cystectomy.
  
  
  METHODS
  Three hundred sixty-four patients underwent radical cystectomy for bladder cancer (BCa) from July 2001 to September 2013. Thirty-seven patients (10%) had a history of pelvic irradiation, and 327 (90%) did not. The Kaplan-Meier method and Cox regression models were applied to evaluate survival outcomes. Diversion-related complications were tabulated.
  
  
  RESULTS
  The proportion of non-organ-confined disease was numerically higher in irradiated than in nonirradiated patients (18 of 37 [49%] vs 117 of 327 [36%] patients, P = .1). The difference in the proportion of T4 disease between the 2 groups was statistically significant (13 of 37 [35%] irradiated vs 37 of 327 [11%] nonirradiated patients, P = .005). Pelvic lymph node dissection could not be performed in 7 of 37 irradiated patients. A nonurothelial carcinoma histology was more frequent in irradiated than in nonirradiated patients (5 of 37 [14%] vs 19 of 327 [6%], P = .003). At 3 years, BCa recurrence-free survival estimates were 70 ± 9% and 77 ± 3% (log-rank P = .5), and BCa-specific survival estimates were 64 ± 9% and 69 ± 3% (log-rank P = .4), for irradiated and nonirradiated patients, respectively. In multivariate analysis, a history of pelvic irradiation was not predictive of BCa recurrence or BCa-specific death. Rates of diversion-related complications did not differ between the 2 groups.
  
  
  CONCLUSIONS
  BCa patients with a history of pelvic irradiation present with more advanced disease. Surgery remains difficult in this group of patients as pelvic lymph node dissection is omitted in approximately 1 of 5 patients. Within limitations, prior pelvic irradiation is not predictive of survival outcomes.
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Department of Urology, Bern University Hospital, Bern, Switzerland. Electronic address: danielphatnguyen@hotmail.com.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nguyen
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Bashir
authors.initials: B
authors.lastname: Al Hussein Al Awamlh
authors.affiliation: Division of Hematology/Medical Oncology, Department of Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Bishoy M
authors.initials: BM
authors.lastname: Faltas
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Padraic
authors.initials: P
authors.lastname: O'Malley
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Abimbola
authors.initials: A
authors.lastname: Ayangbesan
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Igor M
authors.initials: IM
authors.lastname: Inoyatov
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009518:New York / Q000453:epidemiology; D010388:Pelvis / Q000528:radiation effects*; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*