Adding radiation therapy (RT) to adjuvant chemotherapy (AC) after radical cystectomy (RC) for locally advanced bladder cancer does not appear to improve overall survival, according to new data presented at the American Urological Association’s 2022 annual meeting in New Orleans, Louisiana.
In the 2006-2015 National Cancer Database, 1684 patients underwent RC for pT3-4 or node-positive bladder cancer, including 1618 who had adjuvant chemotherapy alone and 66 who had RT+AC within 3 months of surgery. During RT, 45 Gy was applied to the pelvis.
Significantly greater proportions of the RT+AC group than the AC only group had pT4 disease (52% vs 26%), positive surgical margins (44% vs 17%), and treatment at a non-academic facility (75% vs 53%).
Adjusted overall survival rates at 3 and 5 years were similar between groups: 44% and 33% for RT+AC compared with 48% and 36% for AC alone. Further adjustment for baseline characteristics, including pathologic features, revealed no significant difference in overall survival between the groups, John Ernandez, Jr, BA, of Beth Israel Deaconess Medical Center, Boston, Masschusetts, reported on behalf of his team.
“These results highlight the need for prospective trials to better define the potential benefits from [postoperative] RT with regard to symptomatic progression and oncologic outcomes.”
Ernandez J, Kaul S, Fleishman A, et al. Adjuvant chemotherapy plus radiotherapy versus chemotherapy alone for locally advanced bladder cancer after radical cystectomy. Presented at: AUA 2022; May 13-16, 2022, New Orleans, Louisiana. Abstract PD26-06.