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Abstract

Purpose Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. Although radical cystectomy (RC) currently is viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapy-based, bladder-sparing trimodal therapy (TMT) that combines transurethral resection of bladder tumor, chemotherapy for radiation sensitization, and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, this study compared the oncologic outcomes between patients treated with RC or TMT by using a propensity score matched-cohort analysis. Methods Data from patients treated in a multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were reviewed retrospectively. Those who received TMT for MIBC were identified and matched (for sex, cT and cN stage, Eastern Cooperative Oncology Group status, Charlson comorbidity score, treatment date, age, carcinoma in situ status, and hydronephrosis) with propensity scores to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with Cox proportional hazards modeling and a competing risk analysis, respectively. Results A total of 112 patients with MIBC were included after matching (56 who had been treated with TMT, and 56 who underwent RC). The median age was 68.0 years, and 29.5% had stage cT3/cT4 disease. At a median follow-up of 4.51 years, there were 20 deaths (35.7%) in the RC group (13 as a result of BC) and 22 deaths (39.3%) in the TMT group (13 as a result of BC). The 5-year DSS rate was 73.2% and 76.6% in the RC and TMT groups, respectively ( P = .49). Salvage cystectomy was performed in 6 (10.7%) of 56 patients who received TMT. Conclusion In the setting of a MDBCC, TMT yielded survival outcomes similar to those of matched patients who underwent RC. Appropriately selected patients with MIBC should be offered the opportunity to discuss various treatment options, including organ-sparing TMT.

Author information

Kulkarni GS1, Hermanns T1, Wei Y1, Bhindi B1, Satkunasivam R1, Athanasopoulos P1, Bostrom PJ1, Kuk C1, Li K1, Templeton AJ1, Sridhar SS1, van der Kwast TH1, Chung P1, Bristow RG1, Milosevic M1, Warde P1, Fleshner NE1, Jewett MAS1, Bashir S1, Zlotta AR1.​

1Girish S. Kulkarni, Thomas Hermanns, Yanliang Wei, Bimal Bhindi, Raj Satkunasivam, Paul Athanasopoulos, Peter J. Bostrom, Kathy Li, Arnoud J. Templeton, Srikala S. Sridhar, Peter Chung, Robert G. Bristow, Michael Milosevic, Padraig Warde, Neil E. Fleshner, Michael A.S. Jewett, Shaheena Bashir, and Alexandre R. Zlotta, Princess Margaret Cancer Center, University Health Network, University of Toronto; Cynthia Kuk and Alexandre R. Zlotta, Mount Sinai Hospital, University of Toronto; Theodorus H. Van Der Kwast, University Health Network, University of Toronto, Toronto, ON, Canada.