Saving bladders with brachytherapy: implantation technique and results

Abstract

Purpose : To analyze and report the treatment results of brachytherapy for solitary bladder cancer in the Arnhem Radiotherapy Institute. Methods and Materials : Between January 1983 and October 1998, 63 patients with a solitary bladder tumor were treated with a combination of transurethral resection, external beam radiotherapy (EBRT), and interstitial radiotherapy. The indications for bladder-conserving treatment were tumor ≤5 cm, T1G3 ( n = 14), T2G2 ( n = 8), T2G3 ( n = 37), and T3a ( n = 4). The prescribed implant dose was either 55 Gy (range 50–65 Gy) in combination with small pelvis external beam RT, 3–4 fractions of 3.5 Gy ( n = 58), or 30 Gy in combination with 20 fractions of 2 Gy external beam radiotherapy ( n = 5). Brachytherapy was performed with 2–8 137Cs needles until 1995 ( n = 48) and 2–5 afterloading catheters ( 192Ir) since 1996 ( n = 15). Follow-up cystoscopies were performed at 3-month intervals during the first 2 years, then every 6 months for 3 years, and annually after the fifth year. The median follow-up was 4.9 years. Results : Twenty patients developed local recurrences, of which 6 were “true in-implant recurrences,” 12 were in second bladder locations, and 2 were urethral recurrences. All recurrences developed within 2.5 years after treatment. Of these 20 patients, 13 underwent cystectomy: 6 stayed disease-free, 1 died of postoperative complications, 2 developed regional metastases, and 4 developed distant metastases. The 5-year disease-specific survival rate was 80% for patients with Stage T1 and 60% for those with Stage T2 disease. The local control rate was 70% in the whole patient population and 80% after salvage cystectomy. Forty-four bladders were saved. Acute complications were seen in 14 patients, and no significant late complications occurred. Conclusion : Using this treatment technique, a high cure rate with conservation of the bladder and only minor toxicity can be obtained in a selected patient population having a solitary tumor ≤5 cm.