Second transurethral resection and adjuvant radiotherapy in conservative treatment of pT2N0M0 bladder tumors.

Abstract

Because of the high rate of residual tumors after transurethral resection (TUR) and possible pT0 finding on postoperative vesical specimens after initial TUR, we studied the data achieved after a second TUR (reTUR) in pT2N0M0 bladder tumors who underwent adjuvant radiotherapy. Between February 1996 and January 2002, we studied 169 cases (91 males and 78 females) with pT2 bladder tumors, which underwent reTUR within four to six weeks from the initial resection. Tumor location was documented at both procedures on a designed map of the bladder. For the pT2G3 series (40 cases), we practiced laparoscopic lymphadenectomy concomitant with reTUR. For pT0N0 tumors (62 cases), we applied adjuvant external beam radiotherapy (66Gy). For residual tumor after reTUR and N+ cases (107 patients), we applied radical cystectomy. We found 95 cases (56.2%) with residual tumors at reTUR: 4 noninvasive tumors (4.2%), 70 with the same stage (73.7%) and 21 upstaged to pT3 (22.1%). Radical cystectomy was performed in all these cases. For the 74 pT0 cases (43.8%) we applied laparoscopic lymphadenectomy in high-risk tumors (40 G2/3 cases) concomitant with reTUR. So, we found 28 N0 cases (70%) and 12 N+ cases (30%), radical cystectomy being applied in this last series. Finally, for a total of 62 pT0N0 cases under external beam radiotherapy (66Gy) we found 7 cases (11.3%) with local recurrences (3 cases with concomitant lymph node involvement) and 2 cases (3.2%) with systemic disease without local evidence. The disease-free survival was 85.4%. The mean follow-up period was 41 months (range 10-70 months). According to our experience the routine reTUR could detect an important rate of pT0 stage after initial TUR in pT2 bladder tumors. So, reTUR could better select patients for bladder preservation (adjuvant radiotherapy being used), in addition to laparoscopic lymph nodes evaluation for high-risk tumors.