Robot-assisted implantation of brachytherapy catheters promising in bladder cancer

Last Updated: 2017-06-26

By Will Boggs MD

NEW YORK (Reuters Health) - Robot-assisted laparoscopic (RAL) implantation of brachytherapy catheters (BTC) is a minimally invasive alternative to open retropubic surgery, researchers from the Netherlands report.

Brachytherapy is part of a bladder-preserving strategy for patients with bladder cancer, the most common cancer of the urinary tract.

Dr. Judith Bosschieter from VU University Medical Center, in Amsterdam, and colleagues describe their technique and perioperative outcomes for RAL BTC implantation in 26 patients with urothelial or urachal carcinoma in European Urology, online June 14.

RAL BTC implantation was successful in all but two patients (92%), who were found to have perivesical positioning of the BTC and the decision was made to discontinue brachytherapy and treat them with additional external beam radiation therapy (EBRT).

After a median follow-up of 12 months, 65% of patients with urothelial carcinoma were recurrence-free. Five patients (22%) developed metastases without bladder recurrence between two and 29 months postoperatively.

Three urothelial carcinoma patients had local recurrence. The two patients who were treated with additional EBRT instead of brachytherapy remained disease-free four and 15 months later.

The sole patient with urachal carcinoma and successful RAL BTC implantation was recurrence-free after 41 months.

“The 2-yr local recurrence-free survival (80%) is similar to results from the largest published study on patients treated with EBRT and brachytherapy after open implantation,” the researchers note.

Significant complications include an accidentally removed BTC that necessitated RAL repositioning, drainage of an infected lymphocele at 10 days postoperatively, and hydronephrosis necessitating nephrostomy tube placement on the ipsilateral side of the tumor two months postoperatively.

“Our results confirm that the technique is feasible and safe and may have several advantages compared to open implantation in terms of perioperative outcome,” the researchers conclude.

“Further studies and longer follow-up are needed to compare our data and confirm oncological safety,” they add.

Dr. Geert Smits from Rijnstate Hospital Arnhem, in Arnhem, the Netherlands, and colleagues pioneered the minimally invasive assisted surgical technique used in this study.

Dr. Smits, who was not involved in the new work, told Reuters Health by email, “In our overall patient population, we achieved a 100% successful (BTC) implantation resulting in >80% disease-specific survival and local control rates with excellent functional outcomes concerning bladder capacity and control. Until now, we organized international hands-on workshops and performed on-site and remote proctorships for interested teams (until now approximately 20 centers worldwide, including the Amsterdam teams publishing the attached article, visited our center and participated in our workshops).”

“The published results are quite like our experiences in 100-plus patients since 2009,” he said. “In our opinion, this shows clearly that the surgical technique can be reproduced, at least in experienced ‘robot’ hands/robot centers in tight cooperation with radiotherapy departments.”

“This combined robotic surgery and brachytherapy treatment technique can achieve excellent oncological and functional outcomes in well-defined and selected patients with superior quality of life when compared to a radical cystectomy and urine deviation with a stoma or neo-bladder,” Dr. Smits concluded. “For the moment, this technique should be carried out by centers with proven excellent experience in robotic surgery as well as brachytherapy.”

A video of the surgical technique is available at http://bit.ly/2tbPL2J.

Dr. Bosschieter did not respond to a request for comments.

SOURCE: http://bit.ly/2rSIUXq

Eur Urol 2017.