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• W2102722145 abstract "Purpose/Objective(s)More than 70,000 new cases of bladder cancer are diagnosed in the U.S. each year. Surgical resection has been the curative approach of choice, often involving a cystectomy and urinary diversion. Due to the negative impact on quality of life from such treatment, multiple trials have established the feasibility of an initial bladder-sparing approach. The use of this latter approach remains poorly defined.Materials/MethodsPatients diagnosed with nonmetastatic, muscle-invasive bladder cancer between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Each patient's primary treatment was characterized as either definitive surgery (local resection alone or cystectomy +/- radiotherapy [RT]) or definitive RT (RT +/- local resection).ResultsFor the study population of 26,947 patients, 3035 (11.3%) received definitive RT. For these patients, 93.5% also underwent a local excision of the tumor such as a trans-urethral resection of bladder tumor (TURBT). For patients undergoing definitive surgery, only 2.4% also underwent RT (0.7% unknown). On univariate analysis, age, gender, race, tumor grade, year of diagnosis and geographic location were associated with differences in the use of definitive RT (p < 0.001). These differences persisted on multivariate logistic regression analysis for age, race, tumor grade, and geographic location (p < 0.001). Histology also became an independent predictor of definitive RT use on multivariate analysis (p = 0.004). In general, older patients, black patients, and tumors that were poorly differentiated or were squamous cell carcinomas were more likely to be associated with RT use. No significant change in the use of RT was seen over time. Definitive RT was associated with worse overall survival on both Cox univariate and multivariate analyses (HR = 1.79 [95% CI 1.71-1.87], HR = 1.28 [CI 1.22-1.34], respectively). Correlating the use of RT and the independent predictors of survival suggests that patients with poorer expected outcomes are more likely to receive definitive RT.ConclusionsDefinitive radiotherapy is infrequently used for muscle-invasive bladder cancer and its use varies according to patient and tumor characteristics as well as geography. The utilization of this approach has not significantly increased in recent years. Patients who receive definitive RT have worse survival than those receiving definitive surgery, but the patterns of treatment suggest that this may, in part, be due to significant differences in pre-treatment characteristics. In the absence of randomized trials comparing treatment options for bladder cancer, additional analyses are necessary to more precisely delineate which patients may be well-served by a bladder-sparing approach. Purpose/Objective(s)More than 70,000 new cases of bladder cancer are diagnosed in the U.S. each year. Surgical resection has been the curative approach of choice, often involving a cystectomy and urinary diversion. Due to the negative impact on quality of life from such treatment, multiple trials have established the feasibility of an initial bladder-sparing approach. The use of this latter approach remains poorly defined. More than 70,000 new cases of bladder cancer are diagnosed in the U.S. each year. Surgical resection has been the curative approach of choice, often involving a cystectomy and urinary diversion. Due to the negative impact on quality of life from such treatment, multiple trials have established the feasibility of an initial bladder-sparing approach. The use of this latter approach remains poorly defined. Materials/MethodsPatients diagnosed with nonmetastatic, muscle-invasive bladder cancer between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Each patient's primary treatment was characterized as either definitive surgery (local resection alone or cystectomy +/- radiotherapy [RT]) or definitive RT (RT +/- local resection). Patients diagnosed with nonmetastatic, muscle-invasive bladder cancer between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Each patient's primary treatment was characterized as either definitive surgery (local resection alone or cystectomy +/- radiotherapy [RT]) or definitive RT (RT +/- local resection). ResultsFor the study population of 26,947 patients, 3035 (11.3%) received definitive RT. For these patients, 93.5% also underwent a local excision of the tumor such as a trans-urethral resection of bladder tumor (TURBT). For patients undergoing definitive surgery, only 2.4% also underwent RT (0.7% unknown). On univariate analysis, age, gender, race, tumor grade, year of diagnosis and geographic location were associated with differences in the use of definitive RT (p < 0.001). These differences persisted on multivariate logistic regression analysis for age, race, tumor grade, and geographic location (p < 0.001). Histology also became an independent predictor of definitive RT use on multivariate analysis (p = 0.004). In general, older patients, black patients, and tumors that were poorly differentiated or were squamous cell carcinomas were more likely to be associated with RT use. No significant change in the use of RT was seen over time. Definitive RT was associated with worse overall survival on both Cox univariate and multivariate analyses (HR = 1.79 [95% CI 1.71-1.87], HR = 1.28 [CI 1.22-1.34], respectively). Correlating the use of RT and the independent predictors of survival suggests that patients with poorer expected outcomes are more likely to receive definitive RT. For the study population of 26,947 patients, 3035 (11.3%) received definitive RT. For these patients, 93.5% also underwent a local excision of the tumor such as a trans-urethral resection of bladder tumor (TURBT). For patients undergoing definitive surgery, only 2.4% also underwent RT (0.7% unknown). On univariate analysis, age, gender, race, tumor grade, year of diagnosis and geographic location were associated with differences in the use of definitive RT (p < 0.001). These differences persisted on multivariate logistic regression analysis for age, race, tumor grade, and geographic location (p < 0.001). Histology also became an independent predictor of definitive RT use on multivariate analysis (p = 0.004). In general, older patients, black patients, and tumors that were poorly differentiated or were squamous cell carcinomas were more likely to be associated with RT use. No significant change in the use of RT was seen over time. Definitive RT was associated with worse overall survival on both Cox univariate and multivariate analyses (HR = 1.79 [95% CI 1.71-1.87], HR = 1.28 [CI 1.22-1.34], respectively). Correlating the use of RT and the independent predictors of survival suggests that patients with poorer expected outcomes are more likely to receive definitive RT. ConclusionsDefinitive radiotherapy is infrequently used for muscle-invasive bladder cancer and its use varies according to patient and tumor characteristics as well as geography. The utilization of this approach has not significantly increased in recent years. Patients who receive definitive RT have worse survival than those receiving definitive surgery, but the patterns of treatment suggest that this may, in part, be due to significant differences in pre-treatment characteristics. In the absence of randomized trials comparing treatment options for bladder cancer, additional analyses are necessary to more precisely delineate which patients may be well-served by a bladder-sparing approach. Definitive radiotherapy is infrequently used for muscle-invasive bladder cancer and its use varies according to patient and tumor characteristics as well as geography. The utilization of this approach has not significantly increased in recent years. Patients who receive definitive RT have worse survival than those receiving definitive surgery, but the patterns of treatment suggest that this may, in part, be due to significant differences in pre-treatment characteristics. In the absence of randomized trials comparing treatment options for bladder cancer, additional analyses are necessary to more precisely delineate which patients may be well-served by a bladder-sparing approach." @default.
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• W2102722145 date "2010-11-01" @default.
• W2102722145 modified "2023-09-27" @default.
• W2102722145 title "Definitive External Beam Radiotherapy for Muscle-invasive Bladder Cancer: Patterns of Care and Associated Survival" @default.
• W2102722145 doi "https://doi.org/10.1016/j.ijrobp.2010.07.113" @default.
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