BLADDER FUNCTION AFTER CONSERVATIVE SURGERY AND HIGH-DOSE-RATE
BRACHYTHERAPY FOR BLADDER-PROSTATE RHABDOMYOSARCOMA.
Background: Conservative-surgery (CS) brachytherapy (BT) techniques for
local therapy in bladder-prostate rhabdomyosarcoma (BP-RMS) seeks to
retain organ function. We report bladder function after high-dose-rate
(HDR) BT combined with targeted CS for any vesical component of BP-RMS.
Procedure: Prospective cohort of all BP-RMS patients between 2014-19
receiving HDR-BT (Iridium-192, 27.5Gy in 5 fractions) with/without
percutaneous endoscopic-polypectomy (PEP) or partial cystectomy (PC).
Functional assessment included frequency-volume-chart, voided volumes,
post-void residual, flow studies, continence status and ultrasound
scanning; abnormalities triggered video-urodynamics. Results: Thirteen
patients (10 male), aged 9 months to 4 years (median 23 months),
presented with localised fusion-negative embryonal BP-RMS measuring
23-140mm (median 43mm) in cranio-caudal extent. After induction
chemotherapy, local treatment consisted of PC+BT in three, PEP+BT in
four and BT alone in six. At a median 3½ years (range 1¾-7 years) follow
up, all were alive without relapse. At a median age of 6 years (4-9
years), the median bladder capacity was 86% (47%-144%) of that
expected for age, including 75% (74-114%) after PC. There was no
relation to radiation dose to the bladder. Complications occurred in
two: one urethral stricture and one vesical decompensation in a patient
with pre-existing high-grade VUR. The remaining patients are dry by day;
five with anticholinergic medication for urinary urgency. Three patients
are enuretic. Conclusions: Day-time dryness at a median 3½ years after
CS-HDR-BT was achieved in 92%, with 85% voiding urethrally, and 62%
attaining day-and-night continence aged 4-9 years. We report reduced
open surgery, with minimally-invasive percutaneous surgery with HDR-BT
or brachytherapy alone being suitable for many.