Radical Cystectomy Compared to Combined Modality Treatment for Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

Vashistha, Vishal; Wang, Hanzhang; Mazzone, Andrew; Liss, Michael A.; Svatek, Robert S.; Schleicher, Mary; Kaushik, Dharam

doi:10.1016/j.ijrobp.2016.11.056

Cited by 102 publications

(51 citation statements)

References 36 publications

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“…RC entails high risk of re‐operations, long hospital‐stays, long‐term sequelae, and even postoperative mortality . A contemporary bladder‐sparing treatment alternative to RC is chemoradiotherapy . There is no evidence from randomized controlled trials to support superiority of RC over radiotherapy with respect to survival.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 A contemporary bladder-sparing treatment alternative to RC is chemoradiotherapy. [5][6][7][8] There is no evidence from randomized controlled trials to support superiority of RC over radiotherapy with respect to survival. The largest trial to date was closed due to poor accrual, 9 and a recent review concluded that observational studies comparing outcomes of RC to bladder-sparing therapies had serious methodological shortcomings and inconsistent findings.…”

Section: Introductionmentioning

confidence: 99%

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Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study

et al. 2019

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Background Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle‐invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC. Methods We selected patients with muscle‐invasive urothelial carcinoma without distant metastases, treated with radiotherapy or RC from 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe) and estimated absolute and relative risk of bladder cancer death and all‐cause death. In a group of patients, theoretically eligible for a trial comparing radiotherapy and RC, we calculated risk difference in an instrumental variable analysis. We have not investigated chemoradiotherapy as this treatment was not used in the study time period. Results The study included 3 309 patients, of those 17% were treated with radiotherapy and 83% with RC. Patients treated with radiotherapy were older, had more advanced comorbidity, and had a higher risk of death as compared to patients treated with RC (relative risks of 1.5‐1.6). In the “trial population,” all‐cause death risk difference was 6 per 100 patients lower after radiotherapy at 5 years of follow‐up, 95% confidence interval −41 to 29. Conclusion(s) Patient selection between the treatments make it difficult to evaluate results from conventionally adjusted and propensity‐score matched survival analysis. When taking into account unmeasured confounding by instrumental variable analysis, no differences in survival was found between the treatments for a selected group of patients. Further clinical studies are needed to characterize this group of patients, which can serve as a basis for future comparison studies for treatment recommendations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study

et al. 2019

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“…One attempted study, the Selective Bladder Preservation Against Radical Excision (SPARE) trial, was terminated after failing to accrue: the majority of patients refusing randomization at the time of consent expressed a preference for bladder preservation therapy [23]. Although non-randomized comparisons between RT and surgery are inherently biased to favor surgery, systematic literature review and meta-analysis does not support the notion that better outcomes result from a particular approach [24][25][26]. We did not attempt to use SEER to compare survival outcomes between patients receiving RT and cystectomy, because the SEER Program will no longer include the "receipt of radiation" variable without signed recognition from the investigator of the "potential biases associated with radiation data"-an explicit acknowledgement of bias [27].…”

Section: Discussionmentioning

confidence: 99%

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

Wilhite

Routman

Arnett

et al. 2018

Bladder

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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.

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“…8 A non-randomized retrospective study comparing GC to MVAC has shown similar likelihood of downstaging primary tumors and eliminating muscle-invasive disease while also showing less toxicity. 9 Bladder preservation therapy that consists of chemoradiation therapy has traditionally been considered a regimen for highly-selected patients with MIBC who are poor candidates for radical cystectomy or for quality of life purposes (ie those who prefer to preserve their native bladder). 10 While no randomized trials of patients with MIBC have directly compared radical cystectomy and bladder preservation therapy, meta-analysis has shown similar overall 5-year and 10-year survival rates.…”

Section: Introductionmentioning

confidence: 99%

Trends of Muscle Invasive Bladder Cancer: Evidence from the SEER Database, 1988 to 2013

Chalfant

Blute

Zahra

et al. 2020

Preprint

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Background: Guidelines for Muscle-Invasive Bladder cancer (MIBC) recommends that patients receive neoadjuvant chemotherapy with radical cystectomy or chemoradiotherapy, as treatment over radical cystectomy alone. Though trends and practice patterns of MIBC have been defined using the National Cancer Database, data using the Surveillance, Epidemiology, and End Results (SEER) have been poorly described. Methods: Using the SEER database, we collected data of MIBC according to the AJCC (American Joint Commission on Cancer). We considered differences in patient demographics and tumor characteristics based on three treatment groups: chemotherapy with radical cystectomy, radical cystectomy alone, and chemoradiotherapy. Multinomial logistic regression was performed to compare likelihood ratios. Temporal trends of each treatment were compared. Results: Of 16,728 patients, 10,468 patients received radical cystectomy alone, 3,236 received radical cystectomy plus chemotherapy, and 3,024 received chemotherapy plus radiation. Patients who received chemoradiotherapy tended to be older and African American compared to radical cystectomy alone (<.001); stage III patients tended to be divorced (<.001). Patients who received chemotherapy with radical cystectomy tended to be males (<.001); stage II patients were less likely to be Asian than White (<.001). Stage III patients were less likely to receive chemoradiotherapy as a treatment option than stage II (<.001). Chemotherapy with radical cystectomy and chemoradiotherapy are both used less frequently as treatment, though increasingly utilized (<.001). Conclusion: Radical cystectomy alone is still the most commonly used treatment for muscle-invasive bladder cancer based on temporal trends. Significant disparities exist in those who receive chemoradiotherapy over radical cystectomy for treatment.

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Radical Cystectomy Compared to Combined Modality Treatment for Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

Cited by 102 publications

References 36 publications

Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study

Survival after radiotherapy versus radical cystectomy for primary muscle‐invasive bladder cancer: A Swedish nationwide population‐based cohort study

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

Trends of Muscle Invasive Bladder Cancer: Evidence from the SEER Database, 1988 to 2013

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