Top Line: Does trimodality therapy for muscle invasive bladder cancer result in outcomes that are comparable to radical cystectomy?
The Study: There are no randomized trials directly comparing radical cystectomy and trimodality bladder preservation therapy (TURBT and chemoradiation). Beyond the idea of giving patients treatment options, there is concern that many patients who aren’t RC candidates still don’t receive trimodality therapy due to the strong opinions about and limited data on the topic. This retrospective study assembled a cohort of 722 patients with muscle invasive urothelial carcinoma treated (61% RC, 39% trimodality therapy) at 3 academic centers in the US and Canada. Patients were deemed to have been good candidates for either RC or trimodality therapy, and the RC patients represented 29% of all RC patients performed at the 3 institutions over the study period. They had unifocal disease measuring <7cm, no extensive in situ disease, and at most unilateral hydronephrosis. The authors used 2 difference methods to balance treatment groups: propensity score matching and inverse probability treatment weighting. After matching, there were no differences between RC and trimodality therapy in 5 year metastasis free survival (74% v 74%), cancer specific survival (83% v 85%), or disease free survival (76% v 76%) using either statistical method. Overall survival at 5 years actually favored trimodality therapy (77% v 72%). The authors stress that careful selection of patients for trimodality therapy at their institutions, thorough urology surveillance after treatment, and willingness to perform salvage cystectomy, which was done 13% of trimodality patients, is necessary to achieve these outcomes.
TBL: In this large, multicenter, matched analysis, survival outcomes for patients treated with trimodality therapy appear comparable to those who had radical cystectomy. | Zlotta, Lancet Oncol 2023
The Study: There are no randomized trials directly comparing radical cystectomy and trimodality bladder preservation therapy (TURBT and chemoradiation). Beyond the idea of giving patients treatment options, there is concern that many patients who aren’t RC candidates still don’t receive trimodality therapy due to the strong opinions about and limited data on the topic. This retrospective study assembled a cohort of 722 patients with muscle invasive urothelial carcinoma treated (61% RC, 39% trimodality therapy) at 3 academic centers in the US and Canada. Patients were deemed to have been good candidates for either RC or trimodality therapy, and the RC patients represented 29% of all RC patients performed at the 3 institutions over the study period. They had unifocal disease measuring <7cm, no extensive in situ disease, and at most unilateral hydronephrosis. The authors used 2 difference methods to balance treatment groups: propensity score matching and inverse probability treatment weighting. After matching, there were no differences between RC and trimodality therapy in 5 year metastasis free survival (74% v 74%), cancer specific survival (83% v 85%), or disease free survival (76% v 76%) using either statistical method. Overall survival at 5 years actually favored trimodality therapy (77% v 72%). The authors stress that careful selection of patients for trimodality therapy at their institutions, thorough urology surveillance after treatment, and willingness to perform salvage cystectomy, which was done 13% of trimodality patients, is necessary to achieve these outcomes.
TBL: In this large, multicenter, matched analysis, survival outcomes for patients treated with trimodality therapy appear comparable to those who had radical cystectomy. | Zlotta, Lancet Oncol 2023