Goede resultaten van blaassparende behandeling bij slecht gedifferentieerde en invasieve blaascarcinomen met behulp van interstitiële Iridium-192-therapie

To analyse the efficacy and safety of conservative treatment for T1G3 and T2-T3a bladder carcinoma.

Design

Retrospective.

Setting

National Cancer InstituteAnthoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.

Methods

Between 1987 and 1994 (7 years) 63 patients with T1G3 or T2-T3a tumours < 5 cm diameter were treated with a combined approach consisting of a transurethral resection, a course of external irradiation (30 Gy in 15 fractions) to the bladder and an Iridium-192 implant procedure.

Results

After a mean follow-up of 4.2 years (range 3 months to 7.2 years) 42 patients were alive without tumour. Fourteen patients died from bladder cancer and 4 patients died from intercurrent disease. Three patients were alive with non-curable cancer. Nine patients had an isolated bladder relapse. Seven of these could be salvaged with cystectomy (3 patients) or transurethral resection (4 patients). Eight patients developed distant metastases only and 7 patients distant metastases combined with bladder recurrence. The 5 year actuarial survival was 66. Acute and late morbidity was limited and mainly related to the surgical procedure.

Conclusion

Bladder conservation using Iridium-192 implantation is an effective and safe procedure and in a selected group of patients with bladder cancer it is a good alternative to radical cystectomy.