In Regard to Goldsmith and Christadouleas

Abstract

To the Editor: I read with great interest the article by Goldsmith and colleagues ( 1 Goldsmith B. Baumann B.C. He J. et al. Occult pelvic lymph node involvement in bladder cancer: Implications for definitive radiation. Int J Radiat Oncol Biol Phys. 2014; 88: 603-610 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ). They have shown substantial rates of occult pelvic lymph node involvement in clinically staged node-negative bladder cancer, especially in patients with lymphovascular inclusion on biopsy. They have also demonstrated that those patients with involved lymph nodes have differing levels of radiation coverage depending on the size of the pelvic radiation fields ( 1 Goldsmith B. Baumann B.C. He J. et al. Occult pelvic lymph node involvement in bladder cancer: Implications for definitive radiation. Int J Radiat Oncol Biol Phys. 2014; 88: 603-610 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ). Occult Pelvic Lymph Node Involvement in Bladder Cancer: Implications for Definitive RadiationInternational Journal of Radiation Oncology, Biology, PhysicsVol. 88Issue 3PreviewTo inform radiation treatment planning for clinically staged, node-negative bladder cancer patients by identifying clinical factors associated with the presence and location of occult pathologic pelvic lymph nodes. Full-Text PDF In Reply to LeungInternational Journal of Radiation Oncology, Biology, PhysicsVol. 89Issue 3PreviewTo the Editor: We appreciate the reader's thoughtful comments on our article (1, 2). We fully agree that the role of pelvic node radiation in bladder cancer remains unclear. It should be noted, though, that pathologic pelvic node involvement is curable, even without chemotherapy. A recently published cohort of more than 250 bladder cancer patients with pathologically positive lymph nodes undergoing radical cystectomy and pelvic lymph node dissection, without neoadjuvant or adjuvant treatment, showed relapse-free survival rates at 5 and 10 years of 32% and 26%, respectively (3). Full-Text PDF