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Radiochemotherapy After Transurethral Resection for High-Risk T1 Bladder Cancer: An Alternative to Intravesical Therapy or Early Cystectomy?

Christian Weiss, Carolin Wolze, Dirk Gerhard Engehausen, Oliver J. Ott, Frens S. Krause, Karl-Michael Schrott, Jürgen Dunst, Rolf Sauer, Claus Rödel

From the Department of Radiation Therapy, Department of Urology, University of Erlangen, Erlangen; and Department of Radiation Therapy, University of Lübeck, Lübeck, Germany

Address reprint requests to Claus Rödel, MD, Department of Radiation Therapy, Universitätsstr 27, D-91054 Erlangen, Germany; e-mail: claus.roedel{at}strahlen.med.uni-erlangen.de

Purpose For high-risk T1 bladder cancer, the most important issue is how to restrict radical cystectomy to selective patients with a high likelihood of tumor progression and to choose an initial bladder-sparing approach in others without affecting survival. Radiotherapy or radiochemotherapy (RT/RCT) may help to strike a balance between intravesical treatment and early cystectomy.

Patients and Methods Between 1982 and 2004, 141 patients with high-risk T1 bladder cancer (84 patients with T1 grade 3 [T1G3]; others with T1G1/2 and associated carcinoma-in-situ, multifocality, tumor diameter > 5 cm, or multiple recurrences) were treated with RT (n = 28) or platinum-based RCT (n = 113) after transurethral resection of bladder tumor (TURBT). Six weeks after RT/RCT, response was evaluated by restaging TURBT. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response (CR). Median follow-up was 62 months; 65 patients have been observed for 5 years or more.

Results CR was achieved in 121 of 137 patients (88%; four patients without restaging TURBT). Tumor progression for the entire group of 141 patients was 19% and 30% at 5 and 10 years, respectively (for 121 patients with CR, 15% and 29%; for 84 patients with T1G3, 13% and 29%, respectively). Disease-specific survival rates were 82% and 73% at 5 and 10 years (CR, 89% and 79%; T1G3, 80% and 71%, respectively). More than 80% of survivors preserved their bladder; 70.4% were "delighted" or "pleased" with their urinary function.

Conclusion RT/RCT after TURBT with selective bladder preservation is a reasonable alternative to intravesical treatment or early cystectomy for high-risk T1 bladder cancer.

Presented in part at the 47th Annual Meeting of the American Society of Therapeutic Radiology and Oncology, October 16-20, 2005, Denver, CO.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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