The Curie - Da Vinci connection: 5-years’ experience with laparoscopic (robot assisted) implantation for HDR brachytherapy of solitary T2 bladder tumors
Mené sur 57 patients atteints d'un cancer de la vessie de stade T2 traité entre 2009 et 2015 par résection trans-urétrale puis radiothérapie externe (durée médiane de suivi : 2 ans), cette étude évalue la possibilité d'ajouter une curiethérapie à haut débit de dose avec implantation des cathéters par voie laparoscopique, ainsi que son intérêt du point de vue du contrôle de la maladie et de la survie à 2 ans
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. Materials and methods : From 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. 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: 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. 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 with the best results published for a bladder sparing approach.