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Saving bladders with brachytherapy: implantation technique and results.

AbstractPURPOSE:
To analyze and report the treatment results of brachytherapy for solitary bladder cancer in the Arnhem Radiotherapy Institute.
METHODS AND MATERIALS:
Between January 1983 and October 1998, 63 patients with a solitary bladder tumor were treated with a combination of transurethral resection, external beam radiotherapy (EBRT), and interstitial radiotherapy. The indications for bladder-conserving treatment were tumor < or =5 cm, T1G3 (n = 14), T2G2 (n = 8), T2G3 (n = 37), and T3a (n = 4). The prescribed implant dose was either 55 Gy (range 50-65 Gy) in combination with small pelvis external beam RT, 3-4 fractions of 3.5 Gy (n = 58), or 30 Gy in combination with 20 fractions of 2 Gy external beam radiotherapy (n = 5). Brachytherapy was performed with 2-8 137Cs needles until 1995 (n = 48) and 2-5 afterloading catheters (192Ir) since 1996 (n = 15). Follow-up cystoscopies were performed at 3-month intervals during the first 2 years, then every 6 months for 3 years, and annually after the fifth year. The median follow-up was 4.9 years.
RESULTS:
Twenty patients developed local recurrences, of which 6 were "true in-implant recurrences," 12 were in second bladder locations, and 2 were urethral recurrences. All recurrences developed within 2.5 years after treatment. Of these 20 patients, 13 underwent cystectomy: 6 stayed disease-free, 1 died of postoperative complications, 2 developed regional metastases, and 4 developed distant metastases. The 5-year disease-specific survival rate was 80% for patients with Stage T1 and 60% for those with Stage T2 disease. The local control rate was 70% in the whole patient population and 80% after salvage cystectomy. Forty-four bladders were saved. Acute complications were seen in 14 patients, and no significant late complications occurred.
CONCLUSION:
Using this treatment technique, a high cure rate with conservation of the bladder and only minor toxicity can be obtained in a selected patient population having a solitary tumor < or =5 cm.
AuthorsElzbieta M Van der Steen-Banasik, Andries G Visser, Janny G Reinders, Robert P Heijbroek, Jan G Idema, Theodorus G Janssen, Jan Willem Leer
JournalInternational journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 53 Issue 3 Pg. 622-9 (Jul 01 2002) ISSN: 0360-3016 [Print] United States
PMID12062605 (Publication Type: Journal Article)
Topics
  • Aged
  • Aged, 80 and over
  • Brachytherapy (methods)
  • Cystectomy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Radiotherapy Dosage
  • Survival Analysis
  • Urinary Bladder Neoplasms (pathology, radiotherapy, surgery)

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