Abstract
BackgroundRadical cystectomy (RC) with pelvic lymph node dissection (PLND) and urinary diversion (UD) is considered the standard treatment for muscle invasive bladder cancer (MIBC). In a part of patients, RC procedure is aborted due to unresectable disease, other followed treatment like systemic chemotherapy, radiotherapy or cryotherapy may be a better option. The aim of present study was to report the preliminary results of transperineal cryotherapy for unresectable muscle invasive bladder cancer.MethodsFrom January 2011 to August 2013, 7 male patients with pT4b unresectable bladder cancer underwent bilateral ureterocutaneostomy. Two performed a pelvic lymph node dissection (PLND). Then primary transperineal cryosurgery for preserved bladder at the guidance of transrectal ultrasound (TRUS) was performed. All patients underwent a dual freeze-thaw cycle using third-generation cryotechnology with ultrathin 17-gauge cryoneedles. Computer tomography (CT) and/or magnetic resonance image (MRI)were performed at 3 month intervals after cryosurgery to determine whether progression or recurrence occurred.ResultsAll cryosurgery was performed successfully, mean operation time was 76.43 ± 25.12 min (range 50-120 min), mean blood loss was 19.29 ± 15.92 ml (range 5-50 ml). Mean hospital stay was 3.86 ± 1.68 day (range 2-7 days). No operative related deaths occurred. Four patients dead due to the metastasis disease at the follow up time of 8, 15, 18 and 37 months, respectively. Six patients received postoperative therapy, of whom 5 patients were treated with combined chemoradiation, and the other one received chemotherapy alone. The progression free survival (PFS) of the 7 patients was 22.00 ± 14.61 months (range 3-40 months). The one, two and three year overall survival (OS) was 85.7%, 57.1% and 42.9%, respectively.ConclusionOur results suggest that cryosurgery combination with chemoradiotherapy provide a safe and effective alternative method for unresectable pT4b bladder cancer. Longer follow-up is necessary to determine the sustained efficacy.
Highlights
Radical cystectomy (RC) with pelvic lymph node dissection (PLND) and urinary diversion (UD) is considered the standard treatment for muscle invasive bladder cancer (MIBC)
Several reports recently described the utility of cryosurgery in the treatment of bladder cancer through percutaneous or transurethral route and concluded that this precudure could be used as a novel therapeutic approach to the treatment of benign and malignant bladder tumors, especially unresectable tumors and metastatic bladder cancer [4, 5]
All patients had an aborted RC due to unresectable disease secondary to fixation to the pelvis and/or rectum the followed ureterocutaneostomy was performed
Summary
Radical cystectomy (RC) with pelvic lymph node dissection (PLND) and urinary diversion (UD) is considered the standard treatment for muscle invasive bladder cancer (MIBC). The aim of present study was to report the preliminary results of transperineal cryotherapy for unresectable muscle invasive bladder cancer. Several reports recently described the utility of cryosurgery in the treatment of bladder cancer through percutaneous or transurethral route and concluded that this precudure could be used as a novel therapeutic approach to the treatment of benign and malignant bladder tumors, especially unresectable tumors and metastatic bladder cancer [4, 5]. Since 2011, we have performed transperineal cryotherapy in patients who had aborted RC with unresectable disease secondary to fixation to the pelvis and/or rectum and followed ureterocutaneostomy. The aim of the current study was to analyze the preliminary results and to investigate the safety and efficacy of transperineal cryotherapy in our 7 male patients
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