Comparative effectiveness of radical cystectomy and radiotherapy without chemotherapy in frail patients with bladder cancer
Jazyk angličtina Země Švédsko Médium print-electronic
Typ dokumentu srovnávací studie, časopisecké články
- Klíčová slova
- Bladder cancer, bladder sparing, cystectomy, frail, radiotherapy,
- MeSH
- adjuvantní chemoradioterapie metody MeSH
- adjuvantní radioterapie metody MeSH
- cystektomie * MeSH
- cystoskopie MeSH
- hladké svalstvo patologie MeSH
- invazivní růst nádoru MeSH
- Kaplanův-Meierův odhad MeSH
- karcinom z přechodných buněk komplikace mortalita patologie terapie MeSH
- křehkost komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- nádory močového měchýře komplikace mortalita patologie terapie MeSH
- proporcionální rizikové modely MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- staging nádorů MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
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.
Department of Radiotherapy Medical University of Vienna Vienna Austria
Department of Urology 2nd Faculty of Medicine Charles University Prag Czech Republic
Department of Urology Medical University of Vienna Vienna Austria
Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
Division of Urology Department of Surgical Sciences University of Studies of Torino Turin Italy
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