Comparative effectiveness of radical cystectomy and radiotherapy without chemotherapy in frail patients with bladder cancer
Language English Country Sweden Media print-electronic
Document type Comparative Study, Journal Article
- Keywords
- Bladder cancer, bladder sparing, cystectomy, frail, radiotherapy,
- MeSH
- Chemoradiotherapy, Adjuvant methods MeSH
- Radiotherapy, Adjuvant methods MeSH
- Cystectomy * MeSH
- Cystoscopy MeSH
- Muscle, Smooth pathology MeSH
- Neoplasm Invasiveness MeSH
- Kaplan-Meier Estimate MeSH
- Carcinoma, Transitional Cell complications mortality pathology therapy MeSH
- Frailty complications MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Urinary Bladder Neoplasms complications mortality pathology therapy MeSH
- Proportional Hazards Models MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Neoplasm Staging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study 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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