Short-term Mortality Associated with Definitive Chemoradiotherapy Versus Radical Cystectomy for Muscle-invasive Bladder Cancer.

Muscle-invasive bladder cancer (MIBC) may be managed with radical cystectomy (RC) or chemoradiotherapy (CRT). Because patient selection for RC is important to avoid treatment-related mortality, this study addressed a knowledge gap by quantifying short-term mortality with both approaches, as well as predictors thereof.

The National Cancer Database was queried (2004-2014) for clinically staged T2-4aN0M0 MIBC that received either CRT or RC. Statistics included cumulative incidence comparisons of 30- and 90-day mortality between patients treated with either CRT or RC and Cox regression to evaluate predictors thereof.

Of 16,658 patients, 15,208 (91.3%) underwent RC and 1450 (8.7%) CRT. Crude rates of post-treatment mortality at 30 days were 2.7% versus 0.6% (P < .001) and at 90 days were 7.5% versus 4.5% (P = .017) for patients treated with RC and CRT, respectively. When stratifying by age, worse 30- and 90-day mortality with RC was observed for patients aged ≥ 76 years.

This study describes 30- and 90-day mortality following RC versus CRT. Both approaches yield statistically similar treatment-related mortality rates in patients ≤ 75 years of age; however, worse post-treatment mortality was observed with use of RC in patients ≥ 76 years of age. These results may be utilized to better inform shared decision-making between patients and providers when weighing both RC and CRT for MIBC.

Clinical genitourinary cancer. 2019 Jul 02 [Epub ahead of print]

Waqar Haque, Vivek Verma, Monty Aghazadeh, Jorge Darcourt, E Brian Butler, Bin S Teh

Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX. Electronic address: ., Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA., Department of Urology, Houston Methodist Hospital, Houston, TX., Department of Medical Oncology, Houston Methodist Hospital, Houston, TX., Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX.