Radiat Oncol J.
2023 Sep;41(3):154-162. 10.3857/roj.2023.00262.
Comparison of sequential versus concurrent chemoradiation regimens in non-metastatic muscle-invasive bladder cancer
- Affiliations
-
- 1Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
- 2Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- 3Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
- 4Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- KMID: 2546208
- DOI: http://doi.org/10.3857/roj.2023.00262
Abstract
- Purpose
The treatment approach for non-metastatic bladder cancer is guided by an invasion of the muscular layer of the bladder wall. Radical cystectomy is the recommended treatment for muscle-invasive disease. However, it has considerable morbidity and mortality and is not suited for many patients. Trimodality therapy consisting of chemoradiation after transurethral resection of bladder tumor offers a definitive approach with bladder-sparing potential. However, there is a lack of research defining the optimal combination of chemotherapy and radiation in this setting.
Materials and Methods
We extracted patient data from the National Cancer Database to compare survival outcomes and demographic factors in 2,227 non-metastatic bladder cancer patients who were treated with chemotherapy sequential to or concurrently with radiation. Sequential treatment was defined as chemotherapy beginning >14 days before radiation, and concurrent was defined as beginning within 14 days of the first radiation.
Results
The sequential treatment group patients were younger (mean age, 74 vs. 78 years; p < 0.001) with more advanced disease. We found no difference in overall survival between patients who received chemotherapy sequential to radiation and those who received concurrent chemoradiation only (p = 0.533).
Conclusion
Our data are concordant with a previous prospective study, and support that chemotherapy prior to radiation does not decrease survival outcomes relative to patients receiving only concurrent chemoradiation. Given that the sequential group had an overall higher stage but no difference in survival, downstaging chemotherapy prior to radiation may be helpful in these patients. Further studies including a larger, multi-institutional clinical trial are indicated to support clinical decision-making.
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