Bladder cancer radiotherapyBrachytherapy versus cystectomy in solitary bladder cancer: A case control, multicentre, East-Netherlands study
Section snippets
Patients and methods
The Arnhem Radiotherapy Institution has a long history of brachytherapy and bladder tumour is a consistent indication under the following conditions: solitary T1, Grade 3 or T2 tumours < 5 cm in patients fit for surgery and with sufficient bladder function. In order to create two comparable groups we made a selection of the patient population who underwent radical cystectomy in the same geographic area.
Patient characteristics
The patient characteristics are summarised in Table 1. In the brachytherapy group one patient was lost to follow-up, so 76 patients were analysed in the brachytherapy group, 65 patients were analyzed in the cystectomy group.
The follow-up duration appears to be comparable for the two groups: the median follow-up for the brachytherapy group was 5.7 years (range 0.2–21.4 years), for the cystectomy group was 5.05 years (range: 0.04–16.8 years).
As shown in Table 1, significant differences between the
Cystectomy
Twenty-two patients developed recurrences. Time to development of recurrences ranged between 1 and 51 months with a majority of recurrences within 2 years after cystectomy.
Seven patients developed local recurrence only, nine patients developed distant metastases only and six patients suffered from local recurrence combined with distant metastases. Of the patients who experienced lymph node metastases, five had lymph node dissections.
Brachytherapy
Thirty-five patients developed recurrences. All recurrences
Cystectomy
Cystectomy-related adverse events were seen in a total of 47 patients (72%). Acute toxicity (<3 months after cystectomy) was observed in 34 patients (52%) and late toxicity (>3 months after cystectomy) was seen in 30 patients (46%). We analysed and described the adverse events using the Common Toxicity Criteria for Adverse Events 3.0 (see Table 3).
In total two patients died due to cystectomy. One patient died 6 weeks postoperatively because of sepsis after multiple perforations and leakage of the
Discussion
In the urological world there is a broad consensus supporting radical cystectomy for invasive transitional cell carcinoma. Radical cystectomy and pelvic lymph node dissection are considered to be superior to radiation therapy or organ conserving surgery with regard to local control and ultimate cure of muscle-invasive bladder tumours [4]. Five-year survival is dependent upon the pathological stage and nodal status. Five-year survival for patients with muscle-invasive bladder cancer is
Conclusion
Cancer treatment is a matter of multidisciplinary approach. Cystectomy is certainly a widely applicable treatment of choice in infiltrating bladder cancer and improvement of the technique resulting in improvement of the quality of life is impressive. However, a selected group of patients can benefit from an organ sparing procedure by means of a brachytherapy-based combined treatment. The treatment has a very limited, predominantly minor toxicity and the costs are low: hospitalisation of on the
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