Does Chemo-Radiotherapy Improve Survival Outcomes vs. Radiotherapy Alone for High-Grade cT1 Urothelial Carcinoma of the Bladder?

Neal Andruska, Michael R. Waters, Benjamin W. Fischer-Valuck, Zachary L. Smith, Eric H. Kim, Melissa Reimers, Randall Brenneman, Hiram A. Gay, Sagar A. Patel, Jeff M. Michalski, Scott E. Delacroix, Jason A. Efstathiou, Brian C. Baumann

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Non-muscle invasive bladder cancer (non-MIBC) that is high-grade and confined to the lamina propria (HGT1) often has an aggressive clinical course. Currently, there is limited data on the comparative effectiveness of RT vs. CRT for HGT1 non-MIBC. We hypothesized that CRT would be associated with improved overall survival (OS) vs. RT in HGT1 bladder cancer. Methods: Patients diagnosed with HGT1 non-MIBC, and treated with transurethral resection of bladder tumor followed by either treatment with RT alone or CRT, were identified in the National Cancer Database. Inverse probability of treatment weighting (IPTW) was employed and weight-adjusted multivariable analysis (MVA) using Cox regression modeling was used to compare overall survival (OS) hazard ratios. OS was the primary endpoint, and was estimated using the Kaplan-Meier method and log-rank tests. Results: A total of 259 patients with HGT1 UC were treated with: (i) RT alone (n = 123) or (ii) CRT (n = 136). Propensity-weighted MVA showed that combined modality treatment with CRT was associated with improved OS relative to radiation alone (Hazard Ratio [HR]: 0.62, 95% Confidence Interval (95% CI): 0.44-0.88, P = .007). Four-year OS for the CRT vs. RT alone was 36% and 19%, respectively (log-rank P <.008). Conclusion: For patients with HGT1 bladder cancer, concurrent CRT was associated with improved OS compared with radiation alone in a retrospective cohort. These results are hypothesis-generating. The NRG is currently developing a phase II randomized clinical trial comparing CRT to other novel, bladder preservation strategies.

Original languageEnglish
Pages (from-to)653-659.e1
JournalClinical Genitourinary Cancer
Volume21
Issue number6
DOIs
StatePublished - Dec 2023

Keywords

  • Bladder cancer
  • Bladder preservation
  • Inverse probability of treatment weighting
  • National Cancer Database
  • Non-muscle invasive bladder cancer

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