Top Line: What are the long-term outcomes after bladder preservation therapy for muscle invasive bladder cancer?
The Study: BC2001 was a randomized trial that compared radiation alone and chemoradiation for definitive treatment of muscle invasive, node negative bladder cancer. The primary randomization was to RT alone or RT plus concurrent 5FU and mitomycin C (MMC) with a second randomization to whole bladder or partial bladder radiation. Of 458 patients total, 360 underwent chemo randomization while 219 underwent RT volume randomization (including 121 in both randomizations). The original results showed improved locoregional disease-free survival at 2 years with chemoradiation (67% v 54%). The updated results show continued improvement in freedom from recurrence at 5 years with chemoradiation (63% v 49%). In addition, the cystectomy rate at 5 years was significantly lower with chemoradiation (14% v 22%). Five year overall survival was numerically (but not significantly) better with chemoradiation (49% v 37%), and 10 year OS rates were 30% and 26%. After adjusting for prognostic factors, there was also an improvement in bladder cancer specific survival. When it came to the RT volume randomization, treatment outcomes were similar with partial bladder RT, although there was no apparent reduction in toxicity.
TBL: Concurrent chemoradiation provides better long-term locoregional control than radiation alone with survival rates at 5 and 10 years of 49% and 30%. | Hall, Eur Urol 2022