Treatment of malignant bladder tumors by iridium-192 wiring

Botto, Henry; Perrin, Jean Louis; Advert, Jean; Salle, Marcel; Pierquin, B

doi:10.1016/0090-4295(80)90596-8

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…adopted this technique soon afterwards (6,14), whereas Dutch centers did not change their IRT technique until the last 10 years (3,31,53). In a nonrandomized study we did not detect a difference in the complication rate between a group of patients in whom caesium needles were used for IRT and a group of patients in whom the iridium afterloading technique was applied in the same period of time (53).…”

Section: Discussionmentioning

confidence: 82%

143 Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

Wijnmaalen¹,

Helle²,

Koper³

et al. 1996

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To evaluate the results of transurethral resection (TUR), external beam radiotherapy (EBRT), and interstitial radiation (IRT) with iridium-192, using the afterloading technique in patients with muscle invasive bladder cancer. Methods and Materials: From May 1989 until September 1995,66 patients with primary, solitary muscle invasive bladder cancer were treated with TUR, EBRT, and IRT, aiming at bladder preservation. According to the protocol, in three patients low-dose EBRT was applied, whereas 63 patients received high-dose EBRT. Immediately prior to IRT, 42 patients underwent a lymphnode dissection, and in 16 cases a partial cystectomy was performed. For IRT, two to five catheters were used and IRT was started within 24 h after surgery. The majority of patients received 30 Gy of IRT, with a mean dose rate of 58 Gy/h. In three patients, additional EBRT was applied following IRT. Follow-up consisted of regular cystoscopies, mostly done during joint clinics of urologist and radiation oncologist, with urine cytology routinely performed. The median follow-up period was 26 months. The Kaplan-Meier method was used for the determination of survival rates. Results: In seven patients, a bladder relapse developed. The probability of remaining bladder relapse free at 5 years was 88%. The bladder was preserved in 98% of the surviving patients. Metastases developed in 16 patients, and the probability of remaining metastasis free at 5 years was 66%. The cumulative 5-year overall and bladder and distant relapse free survival were 48% and 69%, respectively. Acute toxicity was not serious in the majority of cases; surgical correction of a persisting vesicocutaneous fistula was necessary in two patients, whereas a wound toilet had to be performed in another patient. Serious late toxicity (bladder, RTOG Grade 3) was experienced by only one patient. Conclusions: Interstitial radiation preceded by TUR and EBRT, in a selected group of patients with muscle invasive bladder cancer, yields an excellent bladder tumor control rate with a high probability of bladder preservation. Survival was mainly dependent on the development of distant me&stases. Serious acute and late toxicity was rare.

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Section: Discussionmentioning

confidence: 82%

143 Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

Wijnmaalen¹,

Helle²,

Koper³

et al. 1996

International Journal of Radiation Oncology*Biology*Physics

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“…Low-dose irradiation has been shown to improve the response rate to low-dose intravesical doxorubicin, but the response rates with or without irradiation (18% CR vs. 10% CR) are below that achieved with other intravesical agents 1661. Suprapubic radium needle implantation as done at the Rotterdam Radiotherapy Institute and radium-192 wiring for T, lesions as reported by Botto et a1 have been demonstrated to diminish significantly the tumor recurrence rate in nonrandomized studies [67,68]. Such techniques appear to be useful in experienced hands.…”

Section: Natural History a N D Treatment: Marion Trybula Mdmentioning

confidence: 92%

Superficial bladder cancer

Trybula

King

1985

Med. Pediatr. Oncol.

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A 41-year-old white woman first noted painless hematuria at the age of 16. However, evaluation did not include cystoscopy until 7 years prior to admission, at which time a 3.5 cm diameter grade 11, noninfiltrating bladder carcinoma was noted near the right ureteral orifice. There was no known occupational exposure to carcinogens and the patient did not smoke. Over the ensuing 3 years, multiple grade 1-11 papillary lesions were resected and/or fulgurated. After delivering a full-term baby, the patient was begun on a course of intravesical thiotepa 30 mg weekly for four doses and then once a month maintenance. She experienced an excellent response to this treatment without evidence of recurrent bladder cancer for greater than 1 year. However, after about two years it became clear that thiotepa was no longer effective. Subsequently, she was sequentially treated with intravesical mitomycin C 40 mg every week for eight treatments followed by monthly maintenance, BCG 60 mg weekly for six cycles, and finally doxorubicin 60 mg every 3 weeks without apparent effect. At this point, the patient finally consented to radical cystectomy and formation of an ileo-conduit. The histologic appearance of the bladder demonstrated marked inflammation, fibrosis, and ulceration. There was no evidence of residual tumor. She tolerated this well and has continued to do well 1 year after surgery. LITERATURE REVIEW: Marion Trybula, MDBladder cancer accounted for approximately 4.4% of new cancer diagnoses in 1984 or 38,700 new cases with 10,700 deaths per year [l]. Most patients are between the ages of 50 and 70 years and bladder cancer is 2.6 times as frequent in men as in women. Seventy-five to 85% of new cases will be superficial, ie, Jewett-StrongMarshall Stage 0 (mucosal involvement only) or A (penetration to submucosa without muscle involvement) [2]. These correspond to Tls (carcinoma in situ) and To, and T I , respectively, by the UICC staging systems [3]. About 90% of the tumors are of the transitional cell type while 0 1985 Alan R. Liss, Inc.only 8 % and 2% are of the squamous and adeno types, respectively. The latter are uncommonly superficial and because of their more aggressive natural history and poorer prognosis are not included in most discussions of superficial bladder cancer.

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“…With the development of artificial isotopes, particularly iridium–192, new implantation techniques were developed. The afterloading technique with nylon tube implants was first used in France in 1971 [4]. The main advantage of the iridium–192 is the possibility of afterloading.…”

Section: Discussionmentioning

confidence: 99%