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Long-term risk of salvage cystectomy after radiotherapy for muscle- invasive bladder cancer
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Cooke, P. W., Dunn, Janet A., Latief, T., Bathers, S., James, N. D. and Wallace, D. M. A. (2000) Long-term risk of salvage cystectomy after radiotherapy for muscle- invasive bladder cancer. European Urology, 38 (3). pp. 279-286. doi:10.1159/000020294 ISSN 0302-2838.
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Official URL: https://doi.org/10.1159/000020294
Abstract
Objectives: To establish the long–term outcome for muscle–invasive transitional cell carcinoma of the bladder treated by radiotherapy with or without neoadjuvant cisplatin.Methods: 159 patients with T2–T4a NX M0 bladder cancer were entered into a prospective randomized trial between June 1984 and June 1988. Follow–up was by 3–monthly cystoscopy in the first year, 6–monthly the next 2 years and yearly thereafter. Salvage surgery was performed at the discretion of the participating clinician.Results: Minimum follow–up was 9 (median 11) years, at which time 29 patients (18%) remain alive. Median survival was 24 months with no difference between the treatment groups (χ2 = 0.08, p = 0.77). Overall cystectomy rate was 24% (radiotherapy alone 20%, combined therapy 28%; p = 0.24). Median time to cystectomy from primary treatment was 12 months; range 56 days to 10 years. The risk of cystectomy was 11, 10 and 7% for the first, second and third years after radiotherapy respectively, and 8% in total after the third year. The proportion of patients alive in each successive year who had required a cystectomy was between 20 and 30% for 5 of the first 8 years after treatment.Conclusions: Salvage cystectomy is necessary in a quarter of patients after radiotherapy and this can be needed up to 10 years after treatment. During this time, multiple invasive procedures are likely to be performed, resulting in significant patient morbidity and cost. Patients should be fully counselled about the need for prolonged surveillance and the persisting risk of salvage surgery when deciding between primary cystectomy and radiotherapy.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | European Urology | ||||||
| Publisher: | Elsevier BV | ||||||
| ISSN: | 0302-2838 | ||||||
| Official Date: | September 2000 | ||||||
| Dates: |
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| Volume: | 38 | ||||||
| Number: | 3 | ||||||
| Page Range: | pp. 279-286 | ||||||
| DOI: | 10.1159/000020294 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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