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BLADDER FUNCTION AFTER CONSERVATIVE SURGERY AND HIGH-DOSE-RATE BRACHYTHERAPY FOR BLADDER-PROSTATE RHABDOMYOSARCOMA.
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  • Sara Lobo,
  • Mark Gaze,
  • Olga Slater,
  • Peter Hoskin,
  • Gordon Sands,
  • Tracy Sullivan,
  • Alexander Cho,
  • Gemma Eminowicz,
  • Naima Smeulders
Sara Lobo
Great Ormond Street Hospital For Children NHS Foundation Trust
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Mark Gaze
University College London Hospitals NHS Foundation Trust
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Olga Slater
Great Ormond Street Hospital For Children NHS Trust
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Peter Hoskin
University College London Hospitals NHS Foundation Trust
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Gordon Sands
University College London Hospitals NHS Foundation Trust
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Tracy Sullivan
University College London Hospitals NHS Foundation Trust
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Alexander Cho
Great Ormond Street Hospital For Children NHS Foundation Trust
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Gemma Eminowicz
University College London Hospitals NHS Foundation Trust
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Naima Smeulders
Great Ormond Street Hospital For Children NHS Foundation Trust
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Abstract

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.

Peer review status:UNDER REVIEW

30 Jun 2021Submission Checks Completed
30 Jun 2021Assigned to Editor
30 Jun 2021Submitted to Pediatric Blood & Cancer
01 Jul 2021Reviewer(s) Assigned
22 Jul 2021Review(s) Completed, Editorial Evaluation Pending
23 Jul 2021Editorial Decision: Revise Major
24 Aug 2021Submission Checks Completed
24 Aug 2021Assigned to Editor
24 Aug 20211st Revision Received
25 Aug 2021Reviewer(s) Assigned