Chemoradiation therapy (CRT) and radical cystectomy (RC) are associated with comparable survival outcomes among octogenarians with muscle-invasive bladder cancer (MIBC), according to a retrospective study presented at European Association of Urology’s 38th Annual Congress in Milan, Italy.
The median overall survival (OS) was 28.8 months and 26.1 months with CRT and RC, respectively, a difference that was not statistically significant, study investigator Pushan Prabhakar MD, of the Miami Cancer Institute, Baptist Health South Florida in Miami, reported at the meeting.
Using data from the National Cancer Database, Dr Prabhakar and colleagues compared survival outcomes among 21,095 patients who underwent CRT and RC for localized MIBC (cT2-T4N0M0) from 2004 to 2017. Of these, 4840 were 80 years or older and 16,255 were younger than 80 years. The investigators defined primary CRT as a radiation dose of 39.6 Gy or higher and chemotherapy received within 90 days of radiation without any definitive surgery. Patients in the RC group underwent the surgery with or without perioperative chemotherapy.
In the octogenarian group, 2064 patients (42.6%) underwent primary CRT and 2776 (57.4%) received RC. Among the younger patients, 2,633 (16.2%) had CRT and 13,622 (83.8%) received RC. Using demographic parameters, comorbidity index, and preoperative pathology and stage, the investigators propensity score matched 1767 octogenarians who received CRT with 1767 who underwent RC.
“The most important take-home message for urologists is to individualize patient treatment,” Dr Prabhakar said in an interview. “Chemoradiation therapy could be considered an alternative treatment modality to surgery in elderly patients, given the comparable survival outcomes. While the choice may be difficult, the goal is to find the best definitive treatment modality while balancing the patients’ functional quality of life.”
Marc Smaldone, MD, Professor of Urologic Oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania, said in the absence of level 1 clinical trial evidence, optimal treatment strategies for MIBC remain elusive. “Radical cystectomy with urinary diversion remains the gold standard but the recovery can be complicated and there are significant quality of life implications,” Dr Smaldone said. “These findings highlight that a personalized approach, taking into account tumor biology as well as patients preferences regarding their quality of life, is preferred compared to a ‘one treatment for all’ approach.”
Ganapathi H, Prabhakar P, Kulkarni N, et al. Propensity-score matched survival analysis of octogenarians with muscle-invasive bladder cancer: Chemoradiation compared to radical cystectomy. Presented at: EAU23, March 10-13, 2023, Milan, Italy. Abstract A0157.