Brachytherapy after external beam radiotherapy and limited surgery preserves bladders for patients with solitary pT1–pT3 bladder tumors

Koning, Caro C.E.; Blank, L.E.C.M.; Koedooder, C.; Os, Rob M. van; Kar, Marlou van de; Jansen, E.; Battermann, Jan J.; Beijert, Max; Gernaat, C.; Herpen, K. A. M. van; Hoekstra, C.; Horenblas, Simon; Jobsen, JJ; Krol, Augustinus D.G.; Lybeert, Marnix L.M.; Onna, Ilze E.W. van; Pelger, Rob C.M.; Poortmans, Philip; Pos, Floris J.; Steen-Banasik, E. van der; Slot, Annerie; Visser, A.G.; Pieters, Bradley R.

doi:10.1093/annonc/mds126

Cited by 35 publications

(32 citation statements)

References 25 publications

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“…It is likely that patients in the cystectomy group had tumors with sizes exceeding 5 cm, but this remains unknown for most included studies since tumor size is not a criterion for cystectomy treatment and therefore often not reported. Tumor diameter and tumor stage were not significantly related to local control, as reported for both brachytherapy [12] and cystectomy [16]. However, Cheng et al .…”

Section: Discussionmentioning

confidence: 72%

“…In addition, the analysis on CSS miss data of the largest brachytherapy cohort of Koning et al . [12], which means that this analysis is based on a smaller brachytherapy treatment group than the analysis for OS. Analysis of OS results in better outcomes for the brachytherapy group compared to radical cystectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Articles derived from patients who were included in the large multi-institutional series of Koning et al . [12] were excluded to avoid analysis of double data. In total, 7 studies were included.…”

Section: Methodsmentioning

confidence: 99%

“…This multi-modality approach can be considered in patients with a solitary, stage pT1-pT3, ≤ 5 cm bladder cancer [12]. Recent studies have shown that this multimodality strategy has good results in a selected group of patients [12–14]. An advantage of this conservative approach is the preservation of bladder function.…”

Section: Purposementioning

confidence: 99%

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Bladder preservation with brachytherapy compared to cystectomy for T1-T3 muscle-invasive bladder cancer: a systematic review

Bos¹,

Marmolejo²,

Rasch³

et al. 2014

jcb

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PurposeRadical cystectomy currently is the treatment of choice in muscle-invasive bladder cancer. However, cystectomy is associated with considerable morbidity. Bladder sparing treatment consists of transurethral resection of the tumor (with or without partial cystectomy), external beam radiotherapy, and brachytherapy. The purpose of this study is to compare bladder preservation with brachytherapy to cystectomy by a systematic review.Material and methodsA systematic review was conducted using PubMed electronic database. Article selection was done independently by two authors. Data were extracted on cause-specific survival and overall survival at 2, 5, and 10 years. Comparison of the two treatment modalities was done by a Weibull survival analysis with metaregression analysis and estimation of Hazard Ratio's (HR's) with 95% confidence intervals (CI).ResultsLarge differences in tumor staging and tumor grading were found between cystectomy and bladder sparing series. The adjusted HR's for cause-specific survival and overall survival were 1.27 (95% CI: 1.15-1.40) and 0.85 (95% CI: 0.84-0.87), respectively for bladder sparing relative to radical cystectomy.ConclusionsRobustness of the analysis is hampered by the retrospective character of the study and differences in patient characteristics. For selected cases, bladder sparing by brachytherapy leads to at least similar overall survival compared to radical cystectomy for muscle invasive bladder cancer.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

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Bladder preservation with brachytherapy compared to cystectomy for T1-T3 muscle-invasive bladder cancer: a systematic review

Bos¹,

Marmolejo²,

Rasch³

et al. 2014

jcb

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“…[54][55][56][57] Koning et al 55 included the data of Blank et al but did not report on technique and planning specifically since this was a multicentre trial where every centre used their own technique and planning. Brachytherapy dose varied between 25 and 40 Gy for high-dose EBRT and 50-60 Gy for low-dose EBRT with centre-specific pulse dose.…”

Section: Bladder Cancermentioning

confidence: 99%

A review of the clinical experience in pulsed dose rate brachytherapy

Balgobind

Koedooder

Zúñiga

et al. 2015

BJR

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Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.

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