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자료유형
학술저널
저자정보
금웅섭 (연세대학교) 함원식 (연세대학교) 김현주 (가천대학교) 천재희 (연세대학교) 김태형 (을지의과대학교) 양고운 (연세대학교) 신상준 (연세대학교) 김진성 (연세대학교) 양재문 (연세대학교)
저널정보
연세대학교 의과대학 Yonsei Medical Journal Yonsei Medical Journal 제62권 제7호
발행연도
2021.1
수록면
569 - 576 (8page)

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Purpose: Adjuvant radiotherapy (RT) has been performed to reduce locoregional failure (LRF) following radical cystectomy for locally advanced bladder cancer; however, its efficacy has not been well established. We analyzed the locoregional recurrence patterns of post-radical cystectomy to identify patients who could benefit from adjuvant RT and determine the optimal target volume. Materials and Methods: We retrospectively reviewed 160 patients with stage ≥ pT3 bladder cancer who were treated with radical cystectomy between January 2006 and December 2015. The impact of pathologic findings, including the stage, lympho-vascular invasion, perineural invasion, margin status, nodal involvement, and the number of nodes removed on failure patterns, was assessed. Results: Median follow-up period was 27.7 months. LRF was observed in 55 patients (34.3%), 12 of whom presented with synchronous local and regional failures as the first failure. The most common failure pattern was distant metastasis (40%). Among LRFs, the most common recurrence site was the cystectomy bed (15.6%). Patients with positive resection margins had a significantly higher recurrence rate compared to those without (28% vs. 10%, p=0.004). The pelvic nodal recurrence rate was < 5% in pN0 patients; the rate of recurrence in the external and common iliac nodes was 12.5% in pN+ patients. The rate of recurrence in the common iliac nodes was significantly higher in pN2?3 patients than in pN0?1 patients (15.2% vs. 4.4%, p=0.04). Conclusion: Pelvic RT could be beneficial especially for those with positive resection margins or nodal involvement after radical cystectomy. Radiation fields should be optimized based on the patient-specific risk factors.

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