Comparative effectiveness of radical cystectomy and radiotherapy without chemotherapy in frail patients with bladder cancer

Abstract

Objectives: To evaluate cancer-specific (CSS) and overall survival (OS) in a group of frail patients who were treated with RT without chemotherapy and to compare them with a matched cohort of patients treated with RC.

Methods: This study identified 71 patients treated with RT only for high-risk bladder cancer. Patients with metastatic (cN + or cM+) or non-resectable tumors (cT4) and those who received any form of chemotherapy were excluded. Patients where matched 1:1 using propensity scores which adjusted for the effects of age, clinical stage and age-adjusted Charlson comorbidity index (CCI). OS and CSS were evaluated using the Cox proportional hazards regression model and the Fine and Gray competing risk model.

Results: In the overall population, RT was associated with worse OS (HR = 1.78, 95% CI = 1.15–2.77, p = 0.01) compared to RC, but not with CSS (HR 1.1, p = 0.74). In the matched cohort, RT was neither associated with OS nor CSS (p > 0.05) compared to RC. In the competing risk analyses no statistically significant association of any of the treatments was observed in the total or in the matched data set (p > 0.05).

Conclusion: The use of RT may be an alternative option in well selected patients with limited disease who are considered unfit for systemic chemotherapy and RC. Future research should focus on improving patient selection and assess the quality-of-life as well as the need for reintervention in patients treated with RT.

Keywords:

• Bladder cancer
• bladder sparing
• frail
• cystectomy
• radiotherapy

Informed consent

Due to the retrospective nature of the study, no informed consent was needed

Disclosure statement

Dr. D’Andrea has nothing to disclose; Dr. Soria has nothing to disclose; Dr. Zehetmayer has nothing to disclose; Dr. Stangl-Kremser has nothing to disclose; Dr. Grubmüller has nothing to disclose; Dr. Abufaraj has nothing to disclose; Dr. Gust reports personal fees from Advisory Board: Cepheid, Ferring, Roche and MSD, personal fees from Speaker: Astellas, Astra Zeneca, BMS, Ipsen, Janssen, MSD and Roche, other from Meeting/travel expenses: Allergan, Astellas, Astra Zeneca, Bayer, BMS, Janssen, MSD, Novartis, Pfizer, Pierre Fabre and Roche, outside the submitted work; Dr. Kimura has nothing to disclose; Dr. Babjuk has nothing to disclose; Dr. Goldner has nothing to disclose; Dr. Shariat reports personal fees from Nucleix (Rehovot, Israel) during the conduct of the study; other from Method to determine prognosis after therapy for prostate cancer; Granted 2002-09-06, other from Method to determine prognosis after therapy for bladder cancer; Granted 2003-06-19, other from Prognostic methods for patients with prostatic disease; Granted 2004-08-05, other from Soluble Fas urinary marker for the detection of bladder transitional cell carcinoma; Granted 2010-07-20, other from Astellas, Astra Zeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Janssen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Sanochemia, Sanofi and Wolff, outside the submitted work

Research involving human participants and/or animals

This retrospective study was approved by the ethics committee of Medical University of Vienna (IRB Nr 2196/2018). This article does not contain any studies with animals performed by any of the authors.