title: Neoadjuvant Radiotherapy Improves Survival in Patients With T2b/T3 Bladder Cancer: A Population-Based Analysis.
abstract: BACKGROUND
  Neoadjuvant radiotherapy (NART) for muscle-invasive bladder cancer (MIBC) is currently underused. However, the outcomes for MIBC have remained suboptimal. We investigated the relationship of NART to cause-specific mortality (CSM) and overall mortality (OM) among patients with a diagnosis of MIBC.
  
  
  METHODS
  The patients diagnosed with primary invasive urothelial carcinoma of the bladder from 1983 to 2008 with localized disease were included. Patients aged > 90 years, those diagnosed with T1 or T4 BC, and those with no information on tumor grade were excluded from the analysis. Kaplan-Meier, Cox regression, and competing risk methods were used in the analysis of OM and CSM.
  
  
  RESULTS
  A total of 5562 patients were included in the cohort (115 NART and 5447 surgery alone). On univariate analysis, NART significantly decreased the OM for patients with high-grade BC (hazard ratio [HR], 0.8), stage T2b (HR, 0.74), and stage T2b/T3 (HR, 0.74). CSM was also lower for those with stage T2b disease (HR, 0.63). Multivariable analysis revealed that NART was associated with a significant decrease in CSM (P = .043) and OM (P = .0462) for those with T2b. Likewise, an improvement was seen in OM (P = .0337) for patients with T2b/T3 who had received NART.
  
  
  CONCLUSIONS
  NART was significantly associated with decreased CSM and OM in patients with clinical T2b/T3 BC and OM for patients with T2b/T3. These data suggest that NART could be beneficial in patients with T2b/T3 BC. In the modern era, the greatest utility would potentially be for patients with an incomplete response to neoadjuvant chemotherapy or as an adjunct to chemotherapy to improve the complete response rates.
authors.affiliation: Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL.
authors.forename: Dayssy Alexandra
authors.initials: DA
authors.lastname: Diaz
authors.affiliation: Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL.
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
authors.affiliation: Department of Public Health Sciences, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL.
authors.forename: Isildinha M
authors.initials: IM
authors.lastname: Reis
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Omar
authors.initials: O
authors.lastname: Mahmoud
authors.affiliation: Department of Urology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gonzalgo
authors.affiliation: Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ishkanian
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Fernandez
authors.affiliation: Department of Urology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL.
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.affiliation: Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL. Electronic address: mabramowitz@med.miami.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Abramowitz
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Cause-specific mortality; Cystectomy; Overall mortality; SEER; Surgery