Prior Pelvic Irradiation Does Not Predict Cystectomy Outcomes

Bladder cancer patients with and without a history of pelvic irradiation have similar recurrence-free and cancer-specific survival rates.
Bladder cancer patients with and without a history of pelvic irradiation have similar recurrence-free and cancer-specific survival rates.

Prior pelvic irradiation does not increase bladder cancer patients' risk of disease recurrence or death from the malignancy following radical cystectomy, according to a new study.  

Bladder cancer patients with a history of pelvic irradiation, however, to present with more advanced disease.

Daniel P. Nguyen, MD, of Weill Cornell Medical College-New York Presbyterian Hospital in New York, and colleagues studied 364 patients who underwent radical cystectomy for bladder cancer from July 2001 to September 2013. Of these, 37 (10%) had a history of pelvic irradiation and 327 (90%) did not. The prior irradiation group had a significantly higher proportion of T4 disease than the non-irradiated patients (35% vs. 11%). 

At 3 years, the irradiated and non-irradiated patients had estimated bladder cancer recurrence-free survival rates of 70% and 77%, respectively, and estimated bladder cancer-specific survival rates of 64% and 69%, respectively, Dr. Nguyen's group reported online ahead of print in Urology. None of these between-group differences were statistically significant. In multivariate analysis, a history of pelvic irradiation did not predict bladder cancer recurrence or bladder cancer-specific death. The rates of diversion-related complications between the groups also were not statistically significant.

The researchers noted that pelvic lymph node dissection could not be performed in 7 of the 37 patients with a history of pelvic irradiation.

The indications for prior pelvic irradiation included prostate cancer (30 patients), gynecologic cancer (4 patients), colorectal cancer (2 patients), and testicular seminoma (1 patient).

The authors pointed out that their study was limited to bladder cancer patients who underwent radical cystectomy, so their results cannot be generalized to all patients with a history pelvic irradiation who later develop bladder cancer. Additionally, the study population included a relatively small number of patients with a history of pelvic irradiation.

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