title: Radical cystectomy vs. chemoradiation in T2-4aN0M0 bladder cancer: a case-control study.
abstract: 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.
  
  
  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.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel. Electronic address: ong1000@netvision.net.il.
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Rony
authors.initials: R
authors.lastname: Nof
authors.affiliation: Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Amichai
authors.initials: A
authors.lastname: Meirovitz
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Pode
authors.affiliation: Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Stephen
authors.initials: S
authors.lastname: Frank
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Shapiro
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Ezekiel H
authors.initials: EH
authors.lastname: Landau
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Hidas
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Yutkin
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Duvdevani
authors.affiliation: Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Mark
authors.initials: M
authors.lastname: Wygoda
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D059248:Chemoradiotherapy; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: Chemoradiation; Muscle-invasive bladder cancer; Radical cystectomy