Although radical cystectomy (RC) is considered as the standard therapy for muscle-invasive bladder cancer (MIBC), trimodal therapy (TMT) combining transurethral resection of the tumor with radiotherapy and chemotherapy is increasingly recommended as an alternative approach for bladder preservation. In the absence of randomized trials, we compared the clinical outcomes between RC and TMT using propensity score matching with 50 patients in the RC arm and 29 patients in the TMT arm. With respective median follow-up periods of 23 and 32 months for the RC and TMT groups, 5-year distant metastasis-free survival (58% vs. 67%), overall survival (56% vs. 57%), and cancer-specific survival (69% vs. 63%) rates between the RC and TMT groups, respectively, were similar. However, the 5-year local recurrence-free survival was significantly better in the RC group than in the TMT group (74% vs. 35%). Following TMT, acute grade 3 hematological (n = 2) and late grade 3 genitourinary (n = 1) toxicities were reported. These findings demonstrated that oncological outcomes of TMT were comparable with those of RC, except for poorer local control. Large-scale, randomized trials are warranted to confirm the findings of the present retrospective comparison and to guide toward best treatment options.
Oncotarget. 2017 Mar 25*** epublish ***
Yeon Joo Kim, Sang Jun Byun, Hanjong Ahn, Choung-Soo Kim, Beom-Sik Hong, Sangjun Yoo, Jae-Lyun Lee, Young Seok Kim
Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-Gu, Seoul, Republic of Korea., Urology, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-Gu, Seoul, Republic of Korea., Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Songpa-Gu, Seoul, Republic of Korea.