Trimodality therapy (TMT), consisting of maximal transurethral resection of the bladder tumor followed by concurrent chemoradiotherapy, is an established bladder-preserving option for selected patients with muscle-invasive bladder cancer (MIBC).
However, contemporary multicenter real-world data are needed to better define oncological outcomes and prognostic factors in routine clinical practice.
We conducted a retrospective multicenter cohort study including 369 patients with cT2-T4aN0M0 MIBC treated with definitive TMT between 2010 and 2022. Time-to-event outcomes were measured from radiotherapy completion and estimated using the Kaplan-Meier method. Endpoints included overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), and progression-free survival (PFS). Bladder-preservation outcomes included complete local response (CLR) at first assessment and salvage cystectomy. Prognostic factors were evaluated using multivariable Cox proportional hazards regression.
Median age was 76 years (IQR 66.5-81.0), and 85.1% of patients were male. After a median follow-up of 27.4 months, OS at 1, 2, and 3 years was 85.8%, 75.7%, and 65.7%, respectively, while CSS was 90.5%, 84.7%, and 79.9%. MFS rates at 1, 2, and 3 years were 85.8%, 83.1%, and 80.6%, and corresponding PFS rates were 82.9%, 75.4%, and 71.6%. A complete local response was achieved in 63.7% of patients, and salvage cystectomy was required in 9.7%. On multivariable analysis, increasing age, poorer ECOG performance status, and lymphovascular invasion were independently associated with worse outcomes, whereas the use of modern radiotherapy techniques (IMRT/VMAT) was associated with improved survival compared with three-dimensional conformal radiotherapy.
In this large contemporary real-world cohort, trimodality therapy achieved effective cancer control with durable bladder preservation and a low salvage cystectomy rate. While overall survival was influenced by baseline patient fitness, cancer-specific and metastasis-free outcomes remained favourable. These findings support TMT as a robust bladder-preserving strategy in routine clinical practice, provided that appropriate patient selection and high-quality radiotherapy delivery are ensured.
Actas urologicas espanolas. 2026 Mar 16 [Epub ahead of print]
N Feltes Benítez, F Couñago, S Paredes-Rubio, P Peleteiro Higuero, J G Molina Osorio, A Folgar Torres, A Aissati, A Mera, J R Pastor Peidró, M I Garrido Botella, M González de Dueñas, V Duque-Santana, J Torices Caballero, A Pons Sánchez, J Andreescu Yagüe, A Rodríguez Pérez, S Guardado González, S Fernández Alonso, A Lazo-Prados, M Gaztañaga Boronat, S Moreno López, A Méndez Villamón, R García Gómez, C Gil Restrepo, P Alonso Martínez, F Mesa López, C Ibáñez Villoslada, P Willisch Santamaría, I Ribeiro, C Nicolás Boluda, J Fernández López, F López Campos, P Sargos, E González Del Portillo
Servicio de Oncología Radioterápica, Hospital Universitario de Terrassa (CST), Terrassa, Spain. Electronic address: ., Servicio de Oncología Radioterápica, Hospital La Milagrosa, Madrid, Spain; Servicio de Oncología Radioterápica, Hospital San Francisco de Asís, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Salud y Deporte, Universidad Europea de Madrid, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital Universitario de Terrassa (CST), Terrassa, Spain., Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Servicio de Oncología Radioterápica, Institut Català d'Oncologia (ICO) Badalona, Barcelona, Spain., Servicio de Oncología Radioterápica, Complexo Hospitalario Universitario de Lugo, Lugo, Spain., Servicio de Oncología Radioterápica, Hospital Universitario Dr. Josep Trueta, Girona, Spain., Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Servicio de Oncología Radioterápica, ASCIRES Grupo Biomédico, Valencia, Spain., Servicio de Oncología Radioterápica, Hospital La Milagrosa, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital La Milagrosa, Madrid, Spain; Servicio de Oncología Radioterápica, Hospital San Francisco de Asís, Madrid, Spain., Departamento de Medicina, Facultad de Medicina, Salud y Deporte, Universidad Europea de Madrid, Madrid, Spain; Servicio de Oncología Radioterápica, Hospital Universitario Quirónsalud Madrid, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital Quirónsalud Barcelona, Barcelona, Spain., Servicio de Urología, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain., Servicio de Oncología Radioterápica, GenesisCare Córdoba, Córdoba, Spain., Servicio de Oncología Radioterápica, Hospital Ruber Internacional, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital Universitario 12 de Octubre, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital Universitario Virgen de la Victoria, Málaga, Spain., Servicio de Oncología Radioterápica, Hospital Clínico San Carlos, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital Clínic Barcelona, Barcelona, Spain., Servicio de Oncología Radioterápica, Hospital Universitario Miguel Servet, Zaragoza, Spain., Servicio de Oncología Radioterápica, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Servicio de Oncología Radioterápica, Complejo Asistencial de Zamora, Zamora, Spain., Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Servicio de Oncología Radioterápica, Hospital Universitario Ramón y Cajal, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital Gómez Ulla, Madrid, Spain., Servicio de Oncología Radioterápica, Hospital Meixoeiro, Vigo, Spain., Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain., Servicio de Oncología Radioterápica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain., Servicio de Oncología Radioterápica, Complejo Hospitalario Universitario de Albacete, Albacete, Spain., Servicio de Radioterapia, Institut Bergonié, Bordeaux, France., Servicio de Oncología Radioterápica, Hospital Rey Juan Carlos, Madrid, Spain.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41850565