Increased utilization of external beam radiotherapy relative to cystectomy for localized, muscle-invasive bladder cancer: a SEER analysis

Abstract

OBJECTIVE: To assess recent utilization patterns of radiotherapy (RT) relative to cystectomy for muscle-invasive bladder cancer (MIBC) and evaluate survival trends over time in patients receiving RT. MATERIALS AND METHODS: The surveillance, epidemiology, and end results program (SEER) was used to identify patients diagnosed between 1992 and 2013 with localized MIBC. Patients with a prior history of non-bladder malignancy, who received no treatment, or did not have available treatment information, were excluded. Treatment utilization patterns were assessed using Cochran-Armitage tests for trend, and patient characteristics were compared using chi-square tests. Overall survival (OS) and cause-specific survival (CSS) were estimated using the Kaplan-Meier method. All-cause (ACM) and cause-specific mortality (CSM) were evaluated with multivariable Cox proportional hazards regression. RESULTS: Of 16175 patients analyzed, 11917 (74%) underwent cystectomy, and 4258 (26%) were treated with RT. Patients who received RT were older (median age 79 vs. 68, P < 0.01). Over time, the proportion of patients receiving RT relative to cystectomy increased (24% 1992-2002 vs.

Lack of Evidence Does Not Equal Lack of Benefit: Neoadjuvant Chemotherapy and Trimodality Therapy in Selected Patients with Muscle-Invasive Bladder Cancer

“…There are now more patients who are younger and fitter opting for TMT. [1]. Importantly these patients, unlike the older and frailer patients, are more likely to be eligible for and tolerate NAC.…”

Hospital volume is associated with postoperative mortality after radical cystectomy for treatment of bladder cancer

“…Radical cystectomy (RC) as treatment for bladder cancer is a complex surgical procedure. It is the 'gold standard' in localized carcinoma invading bladder muscle (MIBC) [1], although the role of trimodal therapy is also increasing [2]. The procedure results in substantial postoperative morbidity and mortality.…”