TY - JOUR
T1 - Long-term survival and complications following bladder-preserving brachytherapy in patients with cT1-T2 bladder cancer
AU - Voskuilen, Charlotte S
AU - Bosschieter, Judith
AU - van Werkhoven, Erik
AU - Hendricksen, Kees
AU - Vis, André N
AU - Witteveen, Thelma
AU - Pieters, Bradley R
AU - Burger, Max
AU - Bex, Axel
AU - van der Poel, Henk G
AU - Moonen, Luc M
AU - Horenblas, Simon
AU - Nieuwenhuijzen, Jakko A
AU - van Rhijn, Bas W G
N1 - Copyright © 2019 Elsevier B.V. All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - BACKGROUND AND PURPOSE: Radical cystectomy (RC) is considered standard treatment for muscle-invasive bladder cancer (BC) and high-risk non-muscle invasive BC. In selected cases, bladder-sparing treatment using brachytherapy can be offered. We examined the outcome after brachytherapy in comparison to RC in terms of survival, complications and bladder preservation in patients with cT1G3-T2N0M0 BC.MATERIALS AND METHODS: Between 1988 and 2016, 301 patients underwent brachytherapy in two centres. Overall survival (OS) and disease specific survival (DSS) after brachytherapy and RC were assessed using Kaplan-Meier curves. Cox proportional hazards modelling was used to determine variables associated with OS and DSS. Local recurrences, bladder preservation and salvage cystectomy (SC) after brachytherapy were reported. Complications after brachytherapy, RC and SC were compared using CTCAE criteria.RESULTS: Median follow-up was 9.6 years (95% confidence interval (CI): 8.8-10.4) after brachytherapy and 10.6 years (95% CI: 10.0-11.2) after RC. Five/10-year OS was 66%/49% after brachytherapy and 68%/53% after RC (p = 0.4). Five/10-year DSS was 73%/67% after brachytherapy and 75%/65% after RC (p = 0.8). Intravesical recurrence occurred in 58/259 brachytherapy patients after which salvage cystectomy was performed in 32 patients. In total, 84% of brachytherapy-treated patients preserved their bladder. The brachytherapy cohort experienced less high grade complications than the RC cohort (p = 0.02).CONCLUSION: In selected patients with solitary, ≤5 cm cT1G3-T2N0M0 bladder tumours brachytherapy is a bladder-sparing therapy with good survival outcome and with a favourable complication rate compared to RC.
AB - BACKGROUND AND PURPOSE: Radical cystectomy (RC) is considered standard treatment for muscle-invasive bladder cancer (BC) and high-risk non-muscle invasive BC. In selected cases, bladder-sparing treatment using brachytherapy can be offered. We examined the outcome after brachytherapy in comparison to RC in terms of survival, complications and bladder preservation in patients with cT1G3-T2N0M0 BC.MATERIALS AND METHODS: Between 1988 and 2016, 301 patients underwent brachytherapy in two centres. Overall survival (OS) and disease specific survival (DSS) after brachytherapy and RC were assessed using Kaplan-Meier curves. Cox proportional hazards modelling was used to determine variables associated with OS and DSS. Local recurrences, bladder preservation and salvage cystectomy (SC) after brachytherapy were reported. Complications after brachytherapy, RC and SC were compared using CTCAE criteria.RESULTS: Median follow-up was 9.6 years (95% confidence interval (CI): 8.8-10.4) after brachytherapy and 10.6 years (95% CI: 10.0-11.2) after RC. Five/10-year OS was 66%/49% after brachytherapy and 68%/53% after RC (p = 0.4). Five/10-year DSS was 73%/67% after brachytherapy and 75%/65% after RC (p = 0.8). Intravesical recurrence occurred in 58/259 brachytherapy patients after which salvage cystectomy was performed in 32 patients. In total, 84% of brachytherapy-treated patients preserved their bladder. The brachytherapy cohort experienced less high grade complications than the RC cohort (p = 0.02).CONCLUSION: In selected patients with solitary, ≤5 cm cT1G3-T2N0M0 bladder tumours brachytherapy is a bladder-sparing therapy with good survival outcome and with a favourable complication rate compared to RC.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85073835111&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31630869
U2 - https://doi.org/10.1016/j.radonc.2019.09.026
DO - https://doi.org/10.1016/j.radonc.2019.09.026
M3 - Article
C2 - 31630869
SN - 0167-8140
VL - 141
SP - 130
EP - 136
JO - Radiotherapy and oncology
JF - Radiotherapy and oncology
ER -