Bladder-sparing trimodal therapy (TMT) yields similar outcomes to radical cystectomy among patients with muscle-invasive bladder cancer (MIBC) in a multidisciplinary setting, according to a propensity score analysis published in the Journal of Clinical Oncology.1
There are no randomized trials evaluating the outcomes of TMT in MIBC, though it is a treatment option. The purpose of this study was to use the propensity score matched-cohort method to compare the outcomes of TMT and radical cystectomy.
The study included 112 patients with MIBC who underwent TMT or radical cystectomy between 2008 and 2013. TMT included transurethral tumor resection, chemotherapy, and external beam radiotherapy.
All patients received care from a multidisciplinary team that included a urologic oncologist and radiation oncologist, as well as an expert bladder cancer medical oncologist available for same-day consultation.
The median age of the combined cohort was 68; stage cT3/T4 disease was present in 29.5%; 72% of patients were male.
During a median follow-up of 4.51 years, the mortality rate was 39.3% and 35.7% in the TMT and cystectomy groups, respectively. Salvage cystectomy was performed in 10.7% of the patients in the TMT group, though none were due to bladder toxicity.
There was no difference in the disease-specific survival (DSS) rate between the groups. The 5-year DSS was 76.6% in the TMT group and 73.2% in the RC group.
Overall survival (OS) was similar between groups by univariable and multivariable analyses, with median OS of 6.61 years.
Recurrence occurred in 59% of patients in the TMT group and 38% in the cystectomy group.
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According to the authors, “the success of TMT requires the expertise not only of radiation and medical oncologists to deliver treatment but also of urologic oncologists experienced in surveying postradiation bladders and who can safely perform salvage cystectomy.”
The findings of this analysis suggest that TMT is a reasonable treatment option for appropriately selected patients with MIBC.
- Kulkarni GS, Hermanns T, Wei Y, et al. Propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic. J Clin Oncol. 2017 Apr 14. doi: 10.1200/JCO.2016.69.2327 [Epub ahead of print]