Patients with clinically node-positive bladder cancer without distant metastases can receive bladder-sparing radical dose radiotherapy (RadRT) instead of radical cystectomy (RC) without a reduction in treatment efficacy, according to research published in the Journal of Clinical Oncology.

Researchers found no significant difference in progression-free survival (PFS) or overall survival (OS) whether these patients received RC or RadRT.

This study included 287 patients with clinically node-positive bladder cancer without distant metastases. The patients’ median age was 71 years, and 72% were men. The median follow-up was 4.53 years.

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There were 163 patients who received radical treatment (RadRT or RC) and 124 who received palliative treatment. Palliative treatment included systemic anticancer therapy alone (n=42), palliative RT (n=42), systemic anticancer therapy with palliative RT (n=19), and best supportive care (n=21).

Among the 76 patients who received RC, 50 received systemic anticancer therapy as well, 25 received RC alone, and 1 received RC with adjuvant RT. Among the 87 patients who received RadRT, 19 received it alone, and 68 received systemic anticancer therapy with RadRT.

When compared to patients who received palliative treatment, those who received radical treatment had superior PFS (hazard ratio [HR], 0.36; 95% CI, 0.27-0.46; P <.0001) and OS (HR, 0.30; 95% CI, 0.23-0.39; P <.0001). The median PFS was 1.5 years among patients receiving radical treatment and 0.63 years among patients receiving palliative treatment. The median OS was 2.4 years and 0.89 years, respectively.

Among patients who received radical treatment, there was no significant difference in PFS (P =.07) or OS (P =.5) between those who received RadRT and those who received RC. The median PFS was 1.93 years with RadRT and 1.22 years with RC. The median OS was 2.53 years with RadRT and 2.09 years with RC.

In a multivariate analysis, there was still no significant difference in OS (HR, 0.94; 95% CI, 0.63-1.41; P =.76) or PFS (HR, 0.74; 95% CI, 0.50-1.08; P =.12) between the RadRT and RC groups. However, the researchers did find that receiving chemotherapy was associated with improved PFS (HR, 0.43; 95% CI, 0.27-0.69; P <.01) and OS (HR, 0.53; 95% CI, 0.32-0.87; P =.011).

These results confirm that bladder-sparing therapy should be available to all patients with clinically node-positive bladder cancer without distant metastases, according to the researchers.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Swinton M, Mariam NBG, Tan JL, et al. Bladder-sparing treatment with radical dose radiotherapy is an effective alternative to radical cystectomy in patients with clinically node-positive nonmetastatic bladder cancer. J Clin Oncol. Published online July 21, 2023. doi:10.1200/JCO.23.00725

This article originally appeared on Cancer Therapy Advisor