Although radical cystectomy is considered the standard of care for muscle-invasive bladder cancer (MIBC), recent data has suggested comparable survival outcomes for bladder-sparing trimodality therapy (TMT). We conducted a retrospective, single-institution analysis of MIBC patients to evaluate the efficacy of TMT as an alternative, curative approach to surgical intervention.
We conducted a retrospective analysis of MIBC patients assessed by a multidisciplinary team at the Juravinski Cancer Centre from 2010-2016. Patients underwent transurethral resection of bladder tumor (TURBT) followed by radiotherapy with or without concurrent chemotherapy. Patients could receive neoadjuvant treatment. Clinical data and response rates were summarized, and overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method.
Our analytic cohort included 115 patients, of whom 53 underwent TMT and 62 who underwent radiotherapy alone following TURBT. Median age at diagnosis was 79 years and median followup was 21 months. Complete response rates in those receiving TMT and radiation without chemotherapy were 84.4% and 66.7%, respectively. For TMT patients, three-year OS and DFS were 68.5% and 49.6%, respectively. Patients who received TMT had reduction in risk of mortality (hazard ratio [HR] 0.49; p=0.026) and disease recurrence (HR 0.55; p=0.017) compared to those who had radiation without chemotherapy. Overall, four patients had grade 3 or higher late toxicity.
In this single-institution analysis, TMT appears to be a safe and effective approach in the short-term management of MIBC in appropriately selected patients. Extended followup and analysis are necessary to validate these results.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2019 Nov 05 [Epub ahead of print]
Eric K Nguyen, Hang Yu, Gregory Pond, Bobby Shayegan, Jehonathan H Pinthus, Anil Kapoor, Som D Mukherjee, Alan Neville, Aly-Khan A Lalani, Sebastien J Hotte, Thomas B Corbett, Ian S Dayes, Himanshu R Lukka
Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada., Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada., Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada., Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada., Division of Medical Oncology, McMaster University, Hamilton, ON, Canada.