Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation

Area of Science:

• Urology
• Oncology
• Radiation Oncology

Background:

• Chemoradiation (CRT) is a definitive treatment for muscle-invasive bladder cancer (MIBC).
• CRT is underutilized due to concerns about tolerability and the need for multidisciplinary care.
• Investigating factors influencing CRT discontinuation and its impact is crucial for optimizing patient outcomes.

Purpose of the Study:

• To identify factors associated with treatment discontinuation in patients with MIBC receiving definitive-intent CRT.
• To evaluate the impact of CRT discontinuation on mortality outcomes, including 30-day, 90-day, and overall mortality.

Main Methods:

• Retrospective analysis of the US Veterans Affairs national database (2000-2018).
• Inclusion of patients with urothelial histology and MIBC (T2-4a/N0-3/M0) treated with definitive CRT.
• Multivariable logistic and Cox regression models were used to assess predictors of discontinuation and mortality.

Main Results:

• 8.1% of patients discontinued radiation, primarily due to comorbidities, infections, or treatment intolerance.
• Predictors of discontinuation included creatinine clearance ≤ 50, incomplete transurethral resection of bladder tumor (TURBT), and nonpreferred chemotherapy.
• Discontinuation was associated with significantly higher 30-day, 90-day, and overall mortality, with most deaths attributed to non-bladder cancer causes.

Conclusions:

• CRT is a feasible and effective treatment for elderly and comorbid MIBC patients, with a low discontinuation rate.
• Poor renal function, incomplete TURBT, and chemotherapy choice are key predictors of CRT discontinuation.
• Further research is needed to establish evidence-based guidelines for optimal patient selection for CRT.