BACKGROUND: Muscle-invasive bladder cancer is most commonly treated by radical cystectomy. Patients who are too sick to go through this surgery or who are unwilling to accept the mutilation associated with it are referred to chemoradiation. We compared the results of these 2 modalities using age-matched populations. PARTICIPANTS AND METHODS: Between 1998 and 2008, 33 patients were treated with chemoradiation for biopsy-proven T2-4aN0M0 urothelial bladder cancer. For every patient treated with chemoradiation, an age-matched patient who underwent radical cystectomy on the same year was selected for comparison. Mean radiotherapy dose was 62 Gy (standard deviation = 8.4) and median follow-up of both groups was approximately 36 months. RESULTS: The groups were similar in age, proportion of men, and length of follow-up. However, the Charlson comorbidity index was significantly lower for operated patients (3.45 vs. 4.36, P = 0.01). Furthermore, 2 patients (6%) in the chemoradiation group had salvage cystectomy (one for disease recurrence and another for bladder shrinkage). The 2- and 5-year overall survival rates after surgery were 74.4% and 54.8%, respectively, and after chemoradiation were 70.2% and 56.6% (P = 0.8), respectively. The 2- and 5-year disease-free survival rates after surgery were 67.8% and 63.2%, respectively, and after chemoradiation were 63% and 54.3% (P = 0.89), respectively. Side effects were mild in both groups, with grade 3+toxicity seen in only 2 operated and 4 irradiated patients. CONCLUSIONS: Despite having a significantly higher comorbidity index, patients treated with chemoradiation had similar overall and disease-free survival rates with low toxicity. Treatment with chemoradiation should be considered in patients with T2-4aN0M0 bladder cancer.
BACKGROUND: Muscle-invasive bladder cancer is most commonly treated by radical cystectomy. Patients who are too sick to go through this surgery or who are unwilling to accept the mutilation associated with it are referred to chemoradiation. We compared the results of these 2 modalities using age-matched populations. PARTICIPANTS AND METHODS: Between 1998 and 2008, 33 patients were treated with chemoradiation for biopsy-proven T2-4aN0M0 urothelial bladder cancer. For every patient treated with chemoradiation, an age-matched patient who underwent radical cystectomy on the same year was selected for comparison. Mean radiotherapy dose was 62 Gy (standard deviation = 8.4) and median follow-up of both groups was approximately 36 months. RESULTS: The groups were similar in age, proportion of men, and length of follow-up. However, the Charlson comorbidity index was significantly lower for operated patients (3.45 vs. 4.36, P = 0.01). Furthermore, 2 patients (6%) in the chemoradiation group had salvage cystectomy (one for disease recurrence and another for bladder shrinkage). The 2- and 5-year overall survival rates after surgery were 74.4% and 54.8%, respectively, and after chemoradiation were 70.2% and 56.6% (P = 0.8), respectively. The 2- and 5-year disease-free survival rates after surgery were 67.8% and 63.2%, respectively, and after chemoradiation were 63% and 54.3% (P = 0.89), respectively. Side effects were mild in both groups, with grade 3+toxicity seen in only 2 operated and 4 irradiated patients. CONCLUSIONS: Despite having a significantly higher comorbidity index, patients treated with chemoradiation had similar overall and disease-free survival rates with low toxicity. Treatment with chemoradiation should be considered in patients with T2-4aN0M0 bladder cancer.
Authors: Stephen B Williams; Yong Shan; Usama Jazzar; Hemalkumar B Mehta; Jacques G Baillargeon; Jinhai Huo; Anthony J Senagore; Eduardo Orihuela; Douglas S Tyler; Todd A Swanson; Ashish M Kamat Journal: JAMA Surg Date: 2018-10-01 Impact factor: 14.766
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Authors: Dharam Kaushik; Hanzhang Wang; Joel Michalek; Michael A Liss; Qianqian Liu; Richa Priya Jha; Robert S Svatek; Ahmed M Mansour Journal: Urology Date: 2019-08-08 Impact factor: 2.649
Authors: Stephen B Williams; Yong Shan; Mohamed D Ray-Zack; Hogan K Hudgins; Usama Jazzar; Douglas S Tyler; Stephen J Freedland; Todd A Swanson; Jacques G Baillargeon; Jim C Hu; Sapna Kaul; Ashish M Kamat; John L Gore; Hemalkumar B Mehta Journal: JAMA Surg Date: 2019-08-21 Impact factor: 14.766
Authors: Dharam Kaushik; Zheng Shi; Michael A Liss; Hanzhang Wang; Richa Priya Jha; Byeong Yeob Choi; Deepak K Pruthi; Chul S Ha; Ahmed M Mansour; Robert S Svatek Journal: Urol Oncol Date: 2019-10-29 Impact factor: 3.498
Authors: Dalia O Mohamed; Mona M Sayed; Islam F Abdelkawi; Mahmoud H Elshoieby; Salah M Khallaf; Lamia M Khallaf; Doaa M Fouad Journal: Curr Urol Date: 2021-03-29
Authors: Victor M Schuettfort; Benjamin Pradere; Fahad Quhal; Hadi Mostafaei; Ekaterina Laukhtina; Keiichiro Mori; Reza Sari Motlagh; Margit Fisch; David D'Andrea; Michael Rink; Paolo Gontero; Francesco Soria; Shahrokh F Shariat Journal: World J Urol Date: 2020-09-29 Impact factor: 4.226