Discordance between preoperative and postoperative bladder cancer location: Implications for partial-bladder radiation

Benjamin Goldsmith, Kai Tucker, Robert Greg Conway, Jiwei He, Thomas Guzzo, Justin Bekelman, Curtiland Deville, Neha Vapiwala, S. Bruce Malkowicz, John Christodouleas

Research output: Contribution to journalArticle

Abstract

Purpose: There is strong interest in partial-bladder radiation whether as a boost or definitive therapy to limit long-term toxicity. It is unclear that a standard preoperative examination can accurately identify all sites of disease within the bladder. The purpose of this study was to determine the correlation between preoperative localization of bladder tumors with postoperative findings to facilitate partial-bladder radiation techniques when appropriate. Methods and Materials: We examined patients with clinically staged T1-T4 invasive transitional cell carcinoma (TCC) or TCC with variant histology with no history of radiation or partial cystectomy undergoing radical cystectomy. Patients were scored as "under-detected" if a bladder site was involved with invasive disease (≥T1) at the time of cystectomy, but not identified preoperatively. Patients were additionally scored as "widely under-detected" if they had postoperative lesions that were not identified preoperatively in a given site, nor in any adjacent site. Rates of under-detected and widely under-detected lesions, as well as univariate and multivariate association between clinical variables and under-detection, were evaluated using logistic regression. Results: Among 222 patients, 96% (213/222) had at least 1 area of discordance. Fifty-eight percent of patients were under-detected in at least 1 location, whereas 12% were widely under-detected. Among 24 patients with a single site of disease on preoperative evaluation, 21/24 (88%) had at least 1 under-detected lesion and 14/24 (58%) were widely under-detected. On multivariate analysis, only solitary site of preoperative disease was associated with increased levels of under-detection of invasive disease (OR = 4.161, 95% CI, 1.368-12.657). Conclusion: Our study shows a stark discordance between preoperative and postoperative localization of bladder tumors. From a clinical perspective, incomplete localization of all sites of disease within the bladder may lead to marginal misses when a partial-bladder technique is used.

Original languageEnglish (US)
Pages (from-to)707-713
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume85
Issue number3
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Goldsmith, B., Tucker, K., Conway, R. G., He, J., Guzzo, T., Bekelman, J., Deville, C., Vapiwala, N., Malkowicz, S. B., & Christodouleas, J. (2013). Discordance between preoperative and postoperative bladder cancer location: Implications for partial-bladder radiation. International Journal of Radiation Oncology Biology Physics, 85(3), 707-713. https://doi.org/10.1016/j.ijrobp.2012.05.022