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Patterns of Locoregional Recurrence after Radical Cystectomy for Stage T3-4 Bladder Cancer: A Radiation Oncologist's Point of View

 Hyun Ju Kim  ;  Jaehee Chun  ;  Tae Hyung Kim  ;  Gowoon Yang  ;  Sang Joon Shin  ;  Jin Sung Kim  ;  Jaemoon Yang  ;  Won Sik Ham  ;  Woong Sub Koom 
 YONSEI MEDICAL JOURNAL, Vol.62(7) : 569-576, 2021-07 
Journal Title
Issue Date
Cystectomy* ; Humans ; Neoplasm Recurrence, Local / epidemiology ; Radiation Oncologists ; Retrospective Studies ; Urinary Bladder Neoplasms* / radiotherapy ; Urinary Bladder Neoplasms* / surgery
Urinary bladder neoplasms ; adjuvant radiotherapy ; cystectomy ; recurrence
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.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Jinsung(김진성) ORCID logo https://orcid.org/0000-0003-1415-6471
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Yang, Jae Moon(양재문) ORCID logo https://orcid.org/0000-0001-7365-0395
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
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