Conservative treatment of bladder carcinoma by partial cystectomy and interstitial iridium 192
From 1971 to 1984, 85 patients with bladder carcinoma were treated conservatively at the Henri Mondor Hospital by a combination of short course of pre-operative external pelvic irradiation, iliac node dissection, partial cystectomy, and iridium 192 implantation. There were 79 transitional cell carcinomas (G1: 12, G2: 25, G3: 36, Gx: 6) and 6 squamous cell carcinomas. By clinical stage, based on endoscopic resection, there were 43 T1, 30 T2, 5 T3, and 7 Tx. After partial cystectomy the pathologic stage distribution was: 41 pT1, 31 pT2, and 13 pT3. Crude disease-free survival at 5 years is 72% for T1 tumors and 55% for T2, but overall only 16% of patients died of bladder carcinoma. Local failures were seen in 11.5% of T1 and 0% of T2 tumors, and second bladder tumors developed at a distance from the treated site in 11.5% of T1 and 7% of T2. There is a non significant trend for intravesical recurrences (both local failures and second tumors) to occur more frequently for G1 tumors (25%) than for G2 (16%) or G3 (7%). At 5 years 95% of disease-free survivors have a functioning bladder. Regional or distant metastases occurred in 54% of patients with pT3 tumors and 10% of those with pT1 or pT2; within each stage there was no apparent influence of grade on metastatic risk. The four patients with histologically positive iliac nodes received additional post-operative external pelvic irradiation; three died of metastases and one is disease free at 10 years. No abdominal scar recurrences were seen. Late complications occurred in 6% of the population. For T1 tumors we suggest modification of the described protocol, eliminating the pre-operative irradiation and the lymph node dissection. If there is no doubt as to the pathologic stage after complete endoscopic resection, iridium 192 implantation delivering a dose of 60 Gy, without partial cystectomy, may be sufficient management.
- Research Organization:
- Hospital Henri Mondor, Creteil (France)
- OSTI ID:
- 6609449
- Journal Information:
- Int. J. Radiat. Oncol., Biol. Phys.; (United States), Vol. 15:6
- Country of Publication:
- United States
- Language:
- English
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BLADDER
CARCINOMAS
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IRIDIUM 192
PATIENTS
RADIATION SOURCE IMPLANTS
SURVIVAL CURVES
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BETA-PLUS DECAY RADIOISOTOPES
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HEAVY NUCLEI
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IRIDIUM ISOTOPES
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NEOPLASMS
NUCLEAR MEDICINE
NUCLEI
ODD-ODD NUCLEI
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RADIATION SOURCES
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RADIOLOGY
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YEARS LIVING RADIOISOTOPES
550603* - Medicine- External Radiation in Therapy- (1980-)