An Alternative to Radical Cystectomy

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Bladder-sparing treatment in which brachytherapy is added to external beam radiotherapy (EBRT) may be a valuable alternative for bladder cancer patients who refuse radical cystectomy or who are poor candidates for major surgery, according to researchers.

J.L.H. Ruud Bosch, MD, of University Medical Center Utrecht in the Netherlands, and colleagues reviewed data from 111 patients with solitary T1-T2 bladder tumors (5 cm or less in size). After undergoing transurethral resection of the tumors, patients were treated first with EBRT and then brachytherapy with iridium-192 at a dose of 40 Gy. A partial cystectomy was performed in nine patients, of whom five had a T3 tumor.

The study population had a mean follow-up of 6.2 years.

At the last follow-up, 75 patients were alive without evidence of disease and 17 had died without evidence of disease, the investigators reported in European Urology (2009;56:113-122). Nineteen patients died of bladder cancer after a mean follow-up of 2.9 years.

Overall survival rates at five, 10, and 15 years were 70%, 55%, and 51%, respectively. Disease-specific survival rates were 82%, 73%, and 73%, respectively. Disease-free survival rates were 60%, 47%, and 23%. Patients with T3 tumors had a nearly 20-fold increased risk of dying from bladder cancer.

Additionally, 27% of patients experienced local recurrence and 9% underwent salvage cystectomy. Bladder function was preserved in 99 patients (89%).

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