Radical cystectomy and chemo-radiation are underused for muscle-invasive bladder cancer (MIBC) even though these treatments offer a survival benefit compared with other therapies or no treatment, new findings suggest.

Using the National Cancer Data Base, Angela B. Smith, MD, of the University of North Carolina at Chapel Hill, and colleagues studied 36,469 patients with MIBC. Of these, 27% underwent radical cystectomy, 10% had chemo-radiation, 61% had other therapies, and 2% received no treatment. The other-therapy group include patients who had partial cystectomy, transurethral resection of bladder tumor alone, chemotherapy alone, or radiation alone.

The median follow-up periods for the radical cystectomy, chemo-radiation, other-therapy, and no-therapy groups were similar: 38 months, 33 months, 39 months, and 39 months, respectively. The median overall survival (OS) for the entire cohort was 25.1 months, Dr. Smith’s group reported online ahead of print in BJU International. Radical cystectomy patients had the longest median OS (47.7 months). The median OS was 27.7 months for the chemo-radiation group, 19.7 months for the other-therapy group, and 5.3 months for the no-treatment group.

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In adjusted analyses, radical cystectomy and chemo-radiation were associated with similar overall survival. Compared with patients who had radical cystectomy, those who received other therapies and no therapy had a significant 42% and 2.4-fold increased risk of death.

“An important novel contribution of this study is the observation that chemo-radiation, another guidelines-recommended treatment for MIBC, offers similar OS times to those of radical cystectomy, suggesting a method to address barriers to access to extirpative surgery,” the authors wrote.