- 作者：Elzbieta M. van der Steen-Banasik ; MD&lowast ; ; E.vanderSteen-Banasik@radiotherapiegroep.nl" class="auth_mail" title="E-mail the corresponding author ; Geert A.H.J. Smits ; MD ; PhD&dagger ; ; Bernard J. Oosterveld ; PhD&lowast ; ; Theo Janssen ; RTT&lowast ; ; Andries G. Visser ; PhD&lowast ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2016
- 出版时间：1 August 2016
- 年：2016
- 卷：95
- 期：5
- 页码：1439-1442
- 全文大小：234 K
Methods and Materials
From December 2009 to April 2015, 57 patients with a T2 solitary bladder tumor were treated in Arnhem with transurethral bladder resection followed by external beam irradiation, applied to the bladder and regional iliac lymph nodes, 40 Gy in 20 fractions, 5 fractions per week, and within 1 week interstitial HDR BT, in selected cases combined with partial cystectomy and lymph node dissection. The BT catheters were placed via a transabdominal approach with robotic assistance from a Da Vinci robot after a successful initial experience with a nonrobotic laparoscopic approach. The fraction schedule for HDR was 10 fractions of 2.5 Gy, 3 fractions per day. This was calculated to be equivalent to a reference low-dose-rate schedule of 30 Gy in 60 hours. Data for oncologic outcomes and toxicity (Common Toxicity Criteria version 4) were prospectively collected.
Results
These modifications resulted in an average postoperative hospitalization of 6 days, minimal blood loss, and no wound healing problems. Two patients had severe acute toxicity: 1 pulmonary embolism grade 4 and 1 cardiac death. Late toxicity was mild (n=2 urogenital grade 3 toxicity). The median follow-up was 2 years. Using cumulative incidence competing risk analysis, the 2-year overall, disease-free, and disease-specific survival and local control rates were 59%, 71%, 87%, and 82%, respectively.
Conclusions
The benefits of minimally invasive surgery for implantation of BT catheters and the feasibility of HDR BT in bladder cancer are documented. The patient outcome and adverse events are comparable to the best results published for a bladder-sparing approach.