title: Patterns of Bladder Preservation Therapy Utilization for Muscle-Invasive Bladder Cancer.
abstract: Background:Trimodality bladder preservation therapy (BPT) in muscle invasive bladder cancer (MIBC) includes a maximal transurethral resection followed by concurrent chemoradiotherapy as an alternative to radical cystectomy (RC) in appropriately selected patients, or as a treatment option in non-cystectomy candidates. Several chemotherapy regimens can be used in BPT, but little is known about current practice patterns.Objective:To describe utilization patterns of BPT and associated survival outcomes in MIBC.Methods:Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3,024 consecutive patients from 29 international academic centers from 2005 to 2013. Patients with clinical T2-T4aN0M0 urothelial cancer of the bladder were included.Results:265 patients received BPT. Compared with the 1,447 patients who received RC, BPT patients were older, had poorer performance status, and had more comorbidities (p< 0.01 for all). Median overall survival (OS) was similar for patients treated with curative radiation doses in BPT and patients treated with RC (41 vs 46 months,p= 0.33, respectively). 45% of BPT patients received concurrent chemotherapy with radiation. The most common regimens included cisplatin alone (23%), carboplatin alone (22%), gemcitabine alone (10%), paclitaxel alone (9%), and 5-FU+mitomycin (5%). There were no significant differences in survival among chemotherapy regimens. Only 10 patients (4% of BPT patients) underwent salvage cystectomy.Conclusions:In clinical practice, BPT patients have similar survival to RC patients when treated with curative radiotherapy doses. Choice of concurrent chemotherapy regimen varied widely with no clear standard. Salvage cystectomy is rarely performed. Continued research is needed on the comparative effectiveness among BPT and RC, and among chemotherapy regimens in BPT.
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Rose
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.affiliation: Georges François Leclerc Center, University of Burgundy , Dijon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ladoire
authors.affiliation: Georges François Leclerc Center, University of Burgundy , Dijon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Créhange
authors.affiliation: Icahn School of Medicine at Mount Sinai , New York, NY, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
authors.affiliation: Memorial Sloan Kettering Cancer Center , New York, NY, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Rosenberg
authors.affiliation: Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute , Harvard Medical School, Boston, MA, USA.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.affiliation: Barts Cancer Institute ECMC, Barts Health and the Royal Free NHS Trust, Queen Mary University of London , London, UK.
authors.forename: Akhila
authors.initials: A
authors.lastname: Wimalasingham
authors.affiliation: Fox Chase Cancer Center, Temple University Health System , Philadelphia, PA, USA.
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.affiliation: Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute , Harvard Medical School, Boston, MA, USA.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Harshman
authors.affiliation: Guy's and St. Thomas' Hospital , London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Chowdhury
authors.affiliation: Department of Urology, Medical Faculty, Heinrich-Heine-University , Düsseldorf, Germany.
authors.forename: Guenter
authors.initials: G
authors.lastname: Niegisch
authors.affiliation: University of Athens , Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Liontos
authors.affiliation: Fred Hutchinson Cancer Research Center , Seattle, WA, USA.
authors.forename: Evan Y
authors.initials: EY
authors.lastname: Yu
authors.affiliation: City of Hope Comprehensive Cancer Center , Duarte, CA, USA.
authors.forename: Sumanta K
authors.initials: SK
authors.lastname: Pal
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
authors.forename: Andrew Z
authors.initials: AZ
authors.lastname: Wang
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
keywords: Transitional cell carcinoma; chemoradiotherapy; comparative effectiveness research; cystectomy