Adjuvant Radiotherapy Use by US Radiation Oncologists After Radical Cystectomy for Muscle-invasive Bladder Cancer

Area of Science:

• Urology
• Radiation Oncology
• Oncology

Background:

• Historic trials indicated significant toxicity with adjuvant radiotherapy (ART) after radical cystectomy for muscle-invasive bladder cancer (MIBC).
• Recent trials show improved locoregional control, and NCCN guidelines suggest ART for high-risk MIBC patients.
• Current ART practice patterns among US radiation oncologists are not well-documented.

Purpose of the Study:

• To survey US radiation oncologists to explore current trends in adjuvant radiotherapy (ART) for muscle-invasive bladder cancer (MIBC).
• To identify factors associated with the use of ART in patients with MIBC.

Main Methods:

• A survey was conducted among US radiation oncologists managing patients with cT2-3N0M0 transitional cell MIBC.
• Descriptive statistics were used to report responses.
• Chi-square, univariate, and multivariable logistic regression analyses identified predictors of ART use.

Main Results:

• Nearly half of the 277 surveyed radiation oncologists (46%) have used ART for MIBC.
• Common indications for ART include gross residual disease, positive margins, and pathological nodal involvement.
• Routine pre-cystectomy radiation oncology consultation and intensity-modulated radiotherapy use were significantly associated with ART use.

Conclusions:

• Adjuvant radiotherapy (ART) is unexpectedly common among US radiation oncologists for muscle-invasive bladder cancer (MIBC) despite its controversial nature.
• Factors such as pre-cystectomy consultation and intensity-modulated radiotherapy influence ART utilization.
• Further international trials are needed to clarify the role of ART and identify patient subgroups that benefit.