Background: Trimodality bladder preservation therapy (BPT) in muscle invasive bladder cancer (MIBC) includes a maximal transurethral resection followed by concurrent chemoradiotherapy as an alternative to radical cystectomy (RC) in appropriately selected patients, or as a treatment option in non-cystectomy candidates. Several chemotherapy regimens can be used in BPT, but little is known about current practice patterns. Objective: To describe utilization patterns of BPT and associated survival outcomes in MIBC. Methods: Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3,024 consecutive patients from 29 international academic centers from 2005 to 2013. Patients with clinical T2-T4aN0M0 urothelial cancer of the bladder were included. Results: 265 patients received BPT. Compared with the 1,447 patients who received RC, BPT patients were older, had poorer performance status, and had more comorbidities (p < 0.01 for all). Median overall survival (OS) was similar for patients treated with curative radiation doses in BPT and patients treated with RC (41 vs 46 months, p = 0.33, respectively). 45% of BPT patients received concurrent chemotherapy with radiation. The most common regimens included cisplatin alone (23%), carboplatin alone (22%), gemcitabine alone (10%), paclitaxel alone (9%), and 5-FU+mitomycin (5%). There were no significant differences in survival among chemotherapy regimens. Only 10 patients (4% of BPT patients) underwent salvage cystectomy. Conclusions: In clinical practice, BPT patients have similar survival to RC patients when treated with curative radiotherapy doses. Choice of concurrent chemotherapy regimen varied widely with no clear standard. Salvage cystectomy is rarely performed. Continued research is needed on the comparative effectiveness among BPT and RC, and among chemotherapy regimens in BPT.
Bladder cancer (Amsterdam, Netherlands). 2016 Oct 27*** epublish ***
Tracy L Rose, Allison M Deal, Sylvain Ladoire, Gilles Créhange, Matthew D Galsky, Jonathan E Rosenberg, Joaquim Bellmunt, Akhila Wimalasingham, Yu-Ning Wong, Lauren C Harshman, Simon Chowdhury, Guenter Niegisch, Michalis Liontos, Evan Y Yu, Sumanta K Pal, Ronald C Chen, Andrew Z Wang, Matthew E Nielsen, Angela B Smith, Matthew I Milowsky, Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA., Georges François Leclerc Center, University of Burgundy , Dijon, France., Icahn School of Medicine at Mount Sinai , New York, NY, USA., Memorial Sloan Kettering Cancer Center , New York, NY, USA., Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute , Harvard Medical School, Boston, MA, USA., Barts Cancer Institute ECMC, Barts Health and the Royal Free NHS Trust, Queen Mary University of London , London, UK., Fox Chase Cancer Center, Temple University Health System , Philadelphia, PA, USA., Guy's and St. Thomas' Hospital , London, UK., Department of Urology, Medical Faculty, Heinrich-Heine-University , Düsseldorf, Germany., University of Athens , Athens, Greece., Fred Hutchinson Cancer Research Center , Seattle, WA, USA., City of Hope Comprehensive Cancer Center , Duarte, CA, USA.