Outcomes of brachytherapy similar to cystectomy in muscle-invasive bladder cancer

Issue: November 10, 2011

2011 ASTRO Annual Meeting

MIAMI – Administering brachytherapy after external beam radiotherapy, plus limited surgery, resulted in a bladder conservation rate of 94% among patients with muscle-invasive bladder cancer.

According to E. Deborah Geijsen, MD, and colleagues from the Netherlands, positive data on the outcome of adding brachytherapy to limited surgery following EBRT in early stage muscle-invasive bladder cancer have been reported by French, Belgian and Dutch radiation oncologists. However, this technique is rarely used outside of these countries.

Geijsen presented results during a Scientific Session here at the 2011 ASTRO Annual Meeting.

She and colleagues developed a Dutch database to collect data retrospectively for 1,040 patients treated with both EBRT and brachytherapy at 12 institutions between 1983 and 2010. Partial cystectomy was performed in 247 patients. According to Geijsen, most patients received continuous low-dose rate brachytherapy (n=819). Median patient age was 66 years, and median follow-up was 15 months.

Tumors included: pT0 (n=2), pT1 (n=126), pT2 (n=797), pT3 (n=100), pT4 (n=1) and pTx (n=8). Differentiation grades were: well (n=13), moderately (n=167), poorly (n=824) and undifferentiated (n=16).

The local recurrence rate was 91% at 1 year, 80% at 3 years, and 75% at 5 years; metastasis-free survival was 91% at 1 year, 80% at 3 years, and 74% at 5 years; disease-free survival was 85% at 1 year, 68% at 3 years, and 61% at 5 years; and OS was 91% at 1 year, 74% at 3 years, and 62% at 5 years.

Local recurrence only occurred among 136 patients, both local recurrence and distant metastases among 94 patients and distant metastases only occurred among 145 patients. Forty-nine of the local recurrences were muscle-invasive, 190 were non-muscle-invasive and 31 were both muscle-invasive and non-muscle-invasive; 60 were unknown, according to Geijsen. Sixty patients underwent cystectomy as salvage treatment.

Outcomes were not significantly different among departments. However, type of brachytherapy had a significant effect on recurrence rate in favor of PDR (P<.005). This difference remained constant after multivariate analysis.

“This is the largest cohort of bladder brachytherapy with good local control rates at 5 years of 75%. It is comparable to the cystectomy series, and the bladder conservation rate is 94%. We think that brachytherapy should be offered and discussed with a selected group of patients,” Geijsen said.

For more information:

Geijsen ED. Abstract #141. Presented at: 2011 ASTRO Annual Meeting; Oct. 2-6, 2011; Miami.

Disclosure: The researchers report no relevant financial disclosures.

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