Surgery or Radiotherapy May Confer Similar Survival Rates in Bladder Cancer Subtype

Patients with nonmetastatic node-positive bladder cancer had similar survival outcomes regardless of whether they were treated with surgery or radical dose radiotherapy, as demonstrated by recent study results.

“Our data suggest that patients who are able should undergo radical treatment and that survival outcomes are the same regardless of whether (radical dose radiotherapy) or (radical cystectomy) is received,” the researchers wrote in the study published in the Journal of Clinical Oncology. “Patients who present with (nonmetastatic clinically node-positive bladder cancer) have a poor prognosis and should be counseled as to the most appropriate treatment, empowering them in their decision making with the knowledge that bladder preservation is a real alternative to radical surgery.”

A potential alternative to radical cystectomy (surgical removal of the entire bladder) is bladder-sparing trimodal therapy, which typically involves transurethral resection of the bladder tumor (removal of the tumor in the bladder while leaving the bladder intact) and a radical dose radiotherapy (using high doses) with a concurrent radio-sensitizing agent (this can increase the toxicity of radiation directed to tumor cells while reducing the overall dose needed for the patient). Despite this knowledge, studies have not focused on guiding treatment in patients with nonmetastatic node-positive bladder cancer, which is what researchers conducting this study aimed to do.

Researchers assessed data from 287 patients with nonmetastatic clinically node-positive bladder cancer who underwent treatment at centers that offered both bladder-sparing trimodal therapy and radical cystectomy. Of the radically treated patients (163 patients), 76 patients underwent radical cystectomy and 87 patients underwent radical dose radiotherapy.

The outcomes researchers primarily focused on included overall survival (the time from the start of treatment when a patient with cancer is still alive) and progression-free survival (the time during and after treatment when a patient with cancer lives without disease worsening).

The median overall survival for all patients included in this study was 1.55 years. Patients who underwent radical treatments for nonmetastatic clinically node-positive bladder cancer had improved overall survival rates compared with those who underwent palliative treatment.

The results demonstrated that the choice of radical treatment that patients underwent in the study showed no link with overall survival or progression-free survival. The median overall survival rate for patients treated with radical dose radiotherapy was 2.53 compared with 2.09 for radical cystectomy. For median progression-free survival, these rates were 1.93 and 1.22, respectively.

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