The Curie - Da Vinci connection: 5-years’ experience with laparoscopic (robot assisted) implantation for HDR brachytherapy of solitary T2 bladder tumors

Publication date: Available online 1 April 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Elzbieta M. van der Steen-Banasik, Geert Smits, Bernard J. Oosterveld, Theo Janssen, Andries G. Visser
PurposeTo 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.Materials and methodsFrom December 2009 till April 2015, 57 patients with a T2 solitary bladder tumor were treated in Arnhem with trans urethral bladder resection (TURB) followed by external beam irradiation (EBI), applied to the bladder and regional iliac lymph nodes, 40 Gy in 20 fractions, 5 fractions a week, and within one week interstitial high dose rate (HDR) BT, in selected cases combined with partial cystectomy and lymph node dissection. The BT catheters were placed via a trans-abdominal approach with robotic assistance from a Da Vinci Robot after a successful initial experience with non-robotic laparoscopic approach. The fraction schedule for HDR was 10 fractions of 2.5 Gy, 3 fractions a day. This is calculated to be equivalent to a reference low dose rate schedule of 30 Gy in 60h.Data for oncologic outcomes and toxicity ( Common Toxicity Criteria v.4) were prospectively collected.ResultsThese modifications resulted in an average postoperative hospitalization of 6 days, minimal blood loss and no wound healing problems. Two patients had severe acute toxicity: one pulmonary embolism grade 4 and one cardiac death. Late toxicity was mild (N=2 urogenital grade 3 toxicity). The median follow-up is 2 years. Using cumulative incidence competing risk analysis the 2-year overall , disease free and disease specific survival and local control are: 59%, 71%, 87% and 82%, respectively.ConclusionsThe 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 with the best results published for a bladder sparing approach.

Teaser

From 2009 till 2015 57 patients with solitary pT2 bladder tumors ≤5 cm, received TURB, EBI: 20 fractions of 2 Gy and HDR interstitial brachytherapy: 10 fractions of 2,5 Gy, 3 fractions a day. The implantation of brachytherapy catheters was performed with a robot assisted laparoscopic technique. Minimally invasive surgery was found beneficial in terms of postoperative toxicity and hospitalization time and HDR was found effective with 2-years LC: 82%, DSS: 87% and mild toxicity.


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