[Conservative surgery and iridium 192 in stage pT2 bladder tumor. A 5-year follow up].

Objective: Study of the 5-year oncological results of a series of 24 patients treated by conservative surgery and Iridium 192 for stage pT2 bladder transitional cell carcinoma.
Material and Methods: Retrospective study of 24 patients (mean age: 60 years) treated between March 1979 and June 1988, for a solitary bladder tumour, with a diameter less than 5 cm, without lymphadenopathy or detectable metastases at the time of treatment. Treatment successively consisted of TUR of the lesion for histological diagnosis, preoperative pelvic irradiation of 10.5 Gy, lymph node dissection in 3 patients, insertion of brachytherapy tubes at the resection site (5 cases), associated with lumpectomy (9 cases) or partial cystectomy (10 cases). 18 patients underwent a brachytherapy with doses of 45 to 60 Gy, while 6 patients received a half-dose protocol: brachytherapy 30 Gy + postoperative external beam irradiation (20 to 30 Gy to the tumour site, 30 to 40 Gy to pelvic lymph node chains).
Results: At 5 years, 2 out of 6 deaths were attributable to bladder cancer. 4 other patients died without recurrence, 4 patients relapsed at the site of brachytherapy and/or away from this site, requiring salvage cystectomy in one patient, and repeated TUR +/- BCG therapy in the other three patients. Overall, 18 out of 24 patients were alive at 5 years, 17 had a functional bladder, and 14 were free of recurrence.
Conclusion: Conservative surgery associated with Iridium 192 brachytherapy can be an oncologically reasonable alternative to total cystectomy for selected pT2 bladder tumours: unifocal tumours, less than 5 cm in diameter.