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Abstract
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.

Affiliations

Hyun Ju Kim  1 , Jaehee Chun  2 , Tae Hyung Kim  3 , Gowoon Yang  2 , Sang Joon Shin  4 , Jin Sung Kim  2 , Jaemoon Yang  5 , Won Sik Ham  6 , Woong Sub Koom  7
1 Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea.
2 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
3 Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.
4 Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
5 Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
6 Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. uroham@yuhs.ac.
7 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. mdgold@yuhs.ac.