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Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer.

Abstract：

OBJECTIVE:To evaluate the long-term results of salvage cystectomy after interstitial radiotherapy (IRT) and external beam radiotherapy (EBRT) for transitional cell carcinoma, and to assess the morbidity and functional results of the different urinary diversions used. PATIENTS AND METHODS:The records of 27 patients treated with salvage cystectomy in one institution between 1988 and 2003 were retrospectively analysed. RESULTS:Salvage cystectomy was used after failure of IRT in 14 or EBRT in 13 patients, with a 3- and 5-year survival probability of 46% (95% confidence interval 26-65) and 33 (11-54)%. The 5-year overall survival after cystectomy was 54% after IRT and 14% after EBRT (P = 0.12). Tumour category, response to radiation, American Society of Anesthesiology score, and complete tumour resection had a significant influence on survival. Five of seven patients with incomplete resection died because of local disease, with a median survival of 5 months. There was clinical understaging after radiotherapy in 41% of patients. Nine patients had an orthotopic neobladder, with complete day- and night-time continence in eight and four, respectively. All patients but one had good voiding function. There were early complications in two and late complications in six patients (for Bricker, seven of 14 and none; for Indiana, none of four and two of four). The duration of hospitalization was not influenced by the type of diversion. Erectile function was maintained in four of six patients after a sexuality-preserving cystectomy and neobladder. CONCLUSIONS:Salvage cystectomy can be performed with acceptable morbidity using any type of urinary diversion. Understaging after radiotherapy is common, but preoperative selection needs improving. A very significant factor for an adverse outcome and death from local tumour recurrence was incomplete resection, suggesting that salvage cystectomy should only be attempted if complete resection is probable.

journal_name

BJU Int

journal_title

BJU international

authors

Nieuwenhuijzen JA,Horenblas S,Meinhardt W,van Tinteren H,Moonen LM

doi

10.1111/j.1464-410X.2004.05034.x

keywords:

subject

Has Abstract

pub_date

2004-10-01 00:00:00

pages

793-7

issue

eissn

1464-4096

issn

1464-410X

pii

BJU5034

journal_volume

pub_type

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Salvage cystectomy after failure of interstitial radiotherapy and external beam radiotherapy for bladder cancer.