Management of Superficial Recurrences in an Irradiated Bladder After Combined-Modality Organ-Preserving Therapy

Journal Article · Tue Apr 01 04:00:00 EDT 2008 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.08.007· OSTI ID:21124159

Weiss, Christian ^[1]; Wittlinger, Michael ^[1]; Engehausen, Dirk G; Krause, Frens S ^[2]; Ott, Oliver J ^[1]; Dunst, Juergen ^[3]; Sauer, Rolf ^[1]; Roedel, Claus ^[4]

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1. Department of Radiation Therapy, University of Erlangen, Erlangen (Germany)
2. Department of Urology, University of Erlangen, Erlangen (Germany)
3. Department of Radiation Therapy, University of Luebeck, Luebeck (Germany)
4. Department of Radiation Therapy, University of Frankfurt, Frankfurt (Germany)

Purpose: Standard treatment for superficial bladder cancer is transurethral resection of the bladder tumor (TURBT) followed by intravesical therapy. Little is known about the biologic behavior and treatment response of superficial disease within an irradiated bladder. We specifically analyzed patients who developed superficial recurrence after TURBT and radiotherapy or radiochemotherapy. Patients and Methods: Between 1982 and 2006, a total of 531 consecutive patients with invasive bladder cancer were treated by using various bladder-sparing protocols at our institution. Of these, 389 (76%) achieved a complete response after TURBT and radiotherapy/radiochemotherapy. During follow-up, 68 of 389 patients (17%) developed a superficial local relapse ({<=}T1) and form the subject of this study. Results: Sixty-four of 68 patients underwent conservative TURBT with or without intravesical treatment (4 patients underwent immediate cystectomy): 31 of 64 patients (48%) had no further bladder recurrence, 21 (33%) experienced additional superficial recurrences, and 12 (19%) ultimately progressed to muscle-invasive disease. Disease-specific survival rates were 87% and 72% at 5 and 10 years, respectively. Compared with 255 patients without local bladder relapse after primary treatment, no significant difference was found for disease-specific survival rates (72% after superficial vs. 79% without local relapse at 10 years, p = 0.78). However, significantly fewer patients with a superficial relapse survived with their native bladder (50% after superficial vs. 76% without local relapse at 10 years, p < 0.001). Conclusion: A further bladder-sparing approach with TURBT and intravesical therapy is reasonable for patients with superficial relapse after combined-modality treatment without compromising survival. However, these patients are at greater risk of requiring late cystectomy.

• OSTI ID: 21124159
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 70; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BLADDER
IRRADIATION
MUSCLES
NEOPLASMS
PATIENTS
RADIOTHERAPY