Interstitial brachytherapy for invasive bladder carcinomas. The Nancy experience

From 1975 to 1996, 98 patients with infiltrative vesical carcinomas were treated at the Centre Alexis Vautrin by conservative surgery and interstitial brachytherapy (192Ir). The mean follow-up was about eight years. From his retrospective non randomized study, we tried to determine the tolerance to the treatment. There were 86 men and 12 women. The mean age was 63 years. We found three pTis tumors, 28 stage pT1 tumors, 38 stage pT2 tumors, 24 stage pT3A tumors, four stage pT3B tumors and one stage Tx tumors. The therapeutic scheme consisted of pelvic radiation therapy (3 fractions of 3,5 Gy) immediately followed by lymphadenectomy (for stage pT3 tumors) and by cystostomy or partial cystectomy during which we inserted brachytherapy plastic tubes. The delivered dose was 50 Gy for superficially infiltrative tumors and 30 Gy for deeply infiltrative tumors; at the lowest dose, the treatment ended with external beam irradiation. At 5 years the control rate was 72%, the specific survival 80% and the global survival 71%. Twenty-nine patients had a local recurrence. Of these, seven underwent total cystectomy. Thirteen-seven patients developed 43 complications; 35 were intra-vesical, 10 (28%) were estimated to be higher than grade 2 because of technical problems that led us to modify the technique. It is essential to develop close collaboration between surgeons and brachy-therapists, to select patients and to use a rigorous technique. Interstitial brachytherapy for initiative vesical carcinomas thus yields both high local control and satisfying results in regard to patient's well-being. (authors)