The Curie–Da Vinci Connection: 5-Years' Experience With Laparoscopic (Robot-Assisted) Implantation for High-Dose-Rate Brachytherapy of Solitary T2 Bladder Tumors
| Autor: | G.A.H.J. Smits, Bernard Oosterveld, Theo Janssen, Andries G. Visser, Elzbieta van der Steen-Banasik |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty medicine.medical_treatment Brachytherapy 030232 urology & nephrology Prosthesis Implantation Cystectomy 03 medical and health sciences 0302 clinical medicine Robotic Surgical Procedures Risk Factors Catheterization Peripheral Prevalence medicine Humans Radiology Nuclear Medicine and imaging Cumulative incidence Longitudinal Studies Radiation Injuries Lymph node Survival rate Aged Netherlands Radiation Bladder cancer business.industry Radiotherapy Dosage medicine.disease High-Dose Rate Brachytherapy Surgery Survival Rate Dissection Treatment Outcome medicine.anatomical_structure Urinary Bladder Neoplasms Oncology 030220 oncology & carcinogenesis Feasibility Studies Female Laparoscopy Radiation Dose Hypofractionation business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 95:1439-1442 |
| ISSN: | 0360-3016 |
| Popis: | Purpose To report experience and early results of laparoscopic implantation for interstitial brachytherapy (BT) of solitary bladder tumors and the feasibility of a high-dose-rate (HDR) schedule. 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. |
| Databáze: | OpenAIRE |
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