Top Line: Does radical treatment (surgery or radiation) improve survival for patients with lymph node positive bladder cancer?
The Study: This large, multicenter study from the UK retrospectively reviewed outcomes for 287 patients with cN+ bladder cancer. Of these, just over half received curative intent treatment (57%) while the rest received palliative intent treatment. Among those who received curative treatment, 53% had radiation (78% with chemo) and 47% had radical cystectomy (66% with chemo). In the radiation group, most were treated with hypofractionation, and nodes were covered in only 31%. In the surgery group, 76.3% had a lymph node dissection. Overall, median survival was relatively poor at 1.55 years, so the first question is whether curative treatment improved survival. On multivariable analysis, curative treatment was associated with improved OS (median 2.4 v 0.89 years) and PFS (1.5 v 0.63 years). How did RT and RC compare? There was no difference in median OS (2.53 v 2.09 years), 2 year OS (60% v 51%), or median PFS (1.93 v 1.22 years). Finally, the addition of chemo to RT or RC was associated with improved survival among patients receiving curative treatment.
TBL: In this retrospective study, definitive treatment for node positive bladder cancer was associated with improved survival. There was no difference in survival between radiation and surgery. | Swinton, J Clin Oncol 2023
The Study: This large, multicenter study from the UK retrospectively reviewed outcomes for 287 patients with cN+ bladder cancer. Of these, just over half received curative intent treatment (57%) while the rest received palliative intent treatment. Among those who received curative treatment, 53% had radiation (78% with chemo) and 47% had radical cystectomy (66% with chemo). In the radiation group, most were treated with hypofractionation, and nodes were covered in only 31%. In the surgery group, 76.3% had a lymph node dissection. Overall, median survival was relatively poor at 1.55 years, so the first question is whether curative treatment improved survival. On multivariable analysis, curative treatment was associated with improved OS (median 2.4 v 0.89 years) and PFS (1.5 v 0.63 years). How did RT and RC compare? There was no difference in median OS (2.53 v 2.09 years), 2 year OS (60% v 51%), or median PFS (1.93 v 1.22 years). Finally, the addition of chemo to RT or RC was associated with improved survival among patients receiving curative treatment.
TBL: In this retrospective study, definitive treatment for node positive bladder cancer was associated with improved survival. There was no difference in survival between radiation and surgery. | Swinton, J Clin Oncol 2023