Trimodal therapy in T2-4aN0M0 bladder cancer--How to select the best candidate?
Ofer N Gofrit1, Amichay Meirovitz2, Stephen Frank2
1Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Abstract:
The reported results of trimodal treatment (TMT) in muscle-invasive bladder cancer vary widely. We attempted to characterize the profile of ideal candidates for this approach. Between 2000 and 2019, 105 patients (median age 78 years) with T2-4aN0M0 bladder cancer were treated with TMT and analyzed retrospectively. Mean radiotherapy dose was 62 Gy (SD 8.4). Ten pretreatment prognostic parameters were evaluated including tumor diameter on pre-TURBT CT. Multivariate analyses was performed and combination of parameters was studied. After a median follow-up of 29 months, 53 patients (50.5%) developed recurrence and 70 patients (67.7%) died. Death was disease-specific in 46 patients (65.7%). Tumor diameter was the most significant prognostic parameter with p < 0.0001 for overall, disease-specific and recurrence-free survivals. For every 1 cm increase in tumor diameter, the risk of disease-specific mortality increased by 1.57. Age, cisplatin eligibility and the Charlson Comorbidity Index were significant predictors of overall survival but not of disease-specific or recurrence-free survival. Patients who were cisplatin-eligible with a tumor diameter ≤3 cm had a 5-year disease-specific survival rate of 79.2% as opposed to 33.9% in patients without one of these features (p < 0.001). When tumor diameter exceeded 5 cm (irrelevant of all other parameters), 5-year disease-specific survival rate was only 28.2%. Patient profiles can accurately predict response to TMT. In cisplatin-eligible patients with a tumor diameter ≤3 cm, TMT provides an excellent disease-specific survival rate. In patients with a tumor diameter >5 cm TMT renders unacceptably poor treatment outcomes.
Insights
Trimodal treatment for muscle-invasive bladder cancer shows varied outcomes. Tumor diameter is key; smaller tumors (≤3 cm) in cisplatin-eligible patients yield excellent survival, while larger tumors (>5 cm) result in poor outcomes.
Area of Science:
- Urology
- Oncology
- Radiation Oncology
Background:
- Muscle-invasive bladder cancer (MIBC) treatment outcomes with trimodal therapy (TMT) are inconsistent.
- Identifying ideal patient candidates for TMT is crucial for optimizing treatment efficacy.
Purpose of the Study:
- To characterize the profile of patients most likely to benefit from trimodal treatment for muscle-invasive bladder cancer.
- To identify pretreatment prognostic factors that predict response to TMT.
Main Methods:
- Retrospective analysis of 105 patients with T2-4aN0M0 bladder cancer treated with TMT between 2000 and 2019.
- Evaluation of ten pretreatment prognostic parameters, including tumor diameter on pre-TURBT CT.
- Multivariate analyses to determine the significance of prognostic parameters and their combinations.
Main Results:
- Tumor diameter was the most significant prognostic factor for overall, disease-specific, and recurrence-free survival (p < 0.0001).
- Each 1 cm increase in tumor diameter raised disease-specific mortality risk by 1.57.
- Cisplatin-eligible patients with tumor diameter ≤3 cm had a 5-year disease-specific survival of 79.2%, versus 33.9% for others.
- Patients with tumor diameter >5 cm had a 5-year disease-specific survival of only 28.2%.
Conclusions:
- Patient profiles, particularly tumor diameter and cisplatin eligibility, accurately predict response to trimodal treatment in MIBC.
- TMT offers excellent disease-specific survival for cisplatin-eligible patients with tumors ≤3 cm.
- TMT yields poor outcomes for patients with tumors >5 cm, suggesting alternative strategies may be needed.
