Urethral recurrence after radical radiotherapy for bladder cancer

Purpose: Following cystectomy for bladder cancer, orthotopic reconstruction may result in a decreased risk of urethral recurrence compared to cutaneou s diversion. We evaluate the rate of urethral recurrence after radical exte rnal beam radiotherapy. Materials and Methods: We reviewed the records of 214 men who had received radical radiotherapy at a single center from 1990 to 1995. Patients treated with chemotherapy were excluded from study. Results: A total of 214 men (median age 69 years, range 39 to 86) underwent radical radiotherapy for cure. Tumor stages were T1 in 7%, T2 in 41%, T3 i n 42% and T4a in 10% of the patients. Median followup was 32 months (range I month to 8.4 years) and 5-year survival rate was 30%. Urethral recurrence developed in 7 (3.2%) cases and was detected within 18 months (median 10 m onths, range 3 months to 5 years) of followup in 5. In 2 of these 7 cases r ecurrence developed in the prostatic urethra, and when these 2 cases were e xcluded from analysis the recurrence rate decreased to 2.3%. A total of 64 men completed 5-year followup, with a 4.7% rate of urethral recurrence (3.1 % excluding prostatic urethral recurrence). Multifocal disease, bladder nec k involvement, prostatic disease and cis were possible risk factors for ure thral recurrence. Conclusions: The risk of urethral recurrence after radical radiotherapy for transitional cell carcinoma of the bladder is comparable with that reporte d after orthotopic reconstruction. It is not possible to exclude completely that men at higher risk were offered cystectomy, but the data are consiste nt with the suggestion that continued contact with urine may be protective.