Multimodal therapy for neoplasms arising from a vesical diverticulum

Both radical cystectomy and diverticulectomy for the treatment of neoplasms arising in a vesical diverticulum have resulted in poor survival, mainly secondary to early metastatic spread. In this study, nine patients were treated with a multispecialty approach in hopes of eradicating both local and distant disease. All patients underwent a combination of therapeutic modalities with three patients undergoing pre-operative radiotherapy (RT) and diverticulectomy; diverticulectomy and chemotherapy (three patients): diverticulectomy with chemotherapy and pre-operative RT (two patients); and definitive RT with cisplatin (one patient). With a mean follow-up of 4.0 years (median 3.2), four patients are free of disease, two are dead of other causes, one patient has developed an invasive recurrence, one patient is alive with metastatic disease, and one patient is dead of disease. Five patients (55%) developed local recurrences. Disease-specific survival for the group was 89%. Surgical monotherapy has been ineffective in controlling both local and metastatic disease in patients with diverticular tumors. This study suggests a significant benefit from systemic chemotherapy and RT when combined with surgery for these neoplasms.