Patterns of Locoregional Recurrence after Radical Cystectomy for Stage T3-4 Bladder Cancer:A Radiation Oncologist’s Point of View
10.3349/ymj.2021.62.7.569
- Author:
Hyun Ju KIM
1
;
Jaehee CHUN
;
Tae Hyung KIM
;
Gowoon YANG
;
Sang Joon SHIN
;
Jin Sung KIM
;
Jaemoon YANG
;
Won Sik HAM
;
Woong Sub KOOM
Author Information
1. Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea
- Publication Type:Original Article
- From:Yonsei Medical Journal
2021;62(7):569-576
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Adjuvant radiotherapy (RT) has been performed to reduce locoregional failure (LRF) following radical cystectomy for locally advanced bladder cancer; however, its efficacy has not been well established. We analyzed the locoregional recurrence patterns of post-radical cystectomy to identify patients who could benefit from adjuvant RT and determine the optimal target volume.
Materials and Methods:We retrospectively reviewed 160 patients with stage ≥ pT3 bladder cancer who were treated with radical cystectomy between January 2006 and December 2015. The impact of pathologic findings, including the stage, lympho-vascular invasion, perineural invasion, margin status, nodal involvement, and the number of nodes removed on failure patterns, was assessed.
Results:Median follow-up period was 27.7 months. LRF was observed in 55 patients (34.3%), 12 of whom presented with synchronous local and regional failures as the first failure. The most common failure pattern was distant metastasis (40%). Among LRFs, the most common recurrence site was the cystectomy bed (15.6%). Patients with positive resection margins had a significantly higher recurrence rate compared to those without (28% vs. 10%, p=0.004). The pelvic nodal recurrence rate was < 5% in pN0 patients; the rate of recurrence in the external and common iliac nodes was 12.5% in pN+ patients. The rate of recurrence in the common iliac nodes was significantly higher in pN2–3 patients than in pN0–1 patients (15.2% vs. 4.4%, p=0.04).
Conclusion:Pelvic RT could be beneficial especially for those with positive resection margins or nodal involvement after radical cystectomy. Radiation fields should be optimized based on the patient-specific risk factors.
