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• W2973105086 abstract "Radiotherapy-based management of muscle-invasive bladder cancer (MIBC) is increasingly recognized as an alternative to radical cystectomy, however its use remains controversial. At our institution, bladder-preserving treatment is considered to have equipoise compared to radical cystectomy, particularly in cases with ‘favorable’ features such as cT2 and small (<5cm) primary tumor. We investigated outcomes of this so-called favorable group (FG) compared to a contemporaneous unfavorable cohort of patients (UG). We retrospectively reviewed patients with localized MIBC treated with curative-intent radiotherapy +/- chemotherapy (concurrent and/or neoadjuvant/adjuvant) after maximal transurethral resection of bladder tumor (TURBT) between 2003 and 2017. We examined local control (BLC), distant metastasis-free survival (DMFS), and overall survival (OS) among 1) FG, and 2) UG (either cT3/4, and/or tumor size≥ 5 cm or unknown). Outcomes were estimated using Kaplan-Meier method; and univariable and multivariable analysis were performed using Cox Proportional Hazards Model. In total, 128 patients with localized MIBC were identified; of these 105 (82%), 17 (13%), and 6 (5%) patients had cT2, cT3, and cT4 disease, respectively. Median patient age was 76.5 years (43.0-95.0). Median follow-up was 3.1 years (0.1-11.7). Median recorded tumor size (n=98 [76.6%]) was 3.0 cm (0.5-8.5). There were 71 patients (55.5%) in FG and 57 (44.5%) in UG. Thirty-three patients (19 FG, 14 UG) had no chemotherapy due to comorbidities or preference, and 23 patients (14 FG, 9 UG) were considered unfit for cystectomy. Chemotherapy delivery was: 57 concurrent, 11 neoadjuvant/adjuvant, 27 concurrent and adjuvant/adjuvant. For all patients, 3-year BLC, DMFS, and OS were 64%, 64%, and 82%. At 3 years, BLC of FG and UG were 65% and 61% at 3 years, respectively (not significant [NS]); DMFS were 71% and 57% (p= 0.044), OS were 92% and 69% (NS), respectively. In multivariable analysis cT4 was associated with worse DMFS (HR= 19.5, p<0.001) and OS (HR= 35.3, p<0.001). Similarly, cT3 was associated with worse BLC (HR= 3.2, p= 0.0036). The primary tumor size was not associated with BLC. Overall BLC rates were acceptable, despite one quarter of patients treated without chemotherapy. Bladder local control in FG patients was comparable to the UG group. FG designation was not a useful discriminator for better local outcomes, while cT stage predicted BLS, DMFS, and OS. Large primary tumor did not appear to adversely affect BLC. Further studies to incorporate other factors such as lymphovascular invasion or concurrent carcinoma in-situ will aid oncologists in selecting optimal treatment approach." @default.
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• W2973105086 date "2019-09-01" @default.
• W2973105086 modified "2023-10-16" @default.
• W2973105086 title "Selective Use of Radiation-Based Management in Localized Muscle-Invasive Bladder Cancer" @default.
• W2973105086 doi "https://doi.org/10.1016/j.ijrobp.2019.06.1950" @default.
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