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Benefit of Whole-Pelvis Radiation for Patients With Muscle-Invasive Bladder Cancer: An Inverse Probability Treatment
Gautier Marcq1,2,3, Ronald Kool1,4, Alice Dragomir1
1Department of Urology, McGill University Health Centre, Montreal, Canada.
Summary
Whole-pelvis radiation therapy (WP-RT) improved cancer-specific and overall survival for muscle-invasive bladder cancer patients compared to bladder-only RT. Further trials are needed to confirm these findings for radiation therapy in bladder cancer.
Area of Science:
- Radiation Oncology
- Urologic Oncology
- Clinical Cancer Research
Background:
- The role of pelvic lymph node irradiation in muscle-invasive bladder cancer (MIBC) treated with curative radiation therapy (RT) remains controversial.
- Optimizing RT volumes is crucial for improving oncologic outcomes in MIBC patients.
Purpose of the Study:
- To compare oncologic outcomes between whole-pelvis (WP)-RT and bladder-only (BO)-RT in patients with MIBC undergoing curative RT.
- To evaluate the impact of RT volume on complete response (CR), cancer-specific survival (CSS), and overall survival (OS).
Main Methods:
- A large Canadian multicenter collaborative database was utilized, including 599 patients with MIBC (cT2-4aN0-2M0) treated with curative RT.
- Patients were stratified into WP-RT and BO-RT groups.
- Inverse probability of treatment weighting (IPTW) was employed to balance covariates, followed by multivariable regression analysis to assess outcomes.
Main Results:
- In the IPTW cohort, WP-RT was not associated with improved CR rates (OR, 1.14; P=.526).
- However, WP-RT was significantly associated with improved CSS (HR, 0.66; P=.016) and OS (HR, 0.68; P=.002) compared to BO-RT.
- These survival benefits were independent of other prognostic factors.
Conclusions:
- Whole-pelvis radiation therapy demonstrated superior survival outcomes compared to bladder-only radiation therapy in adjusted analyses for MIBC.
- Randomized controlled trials are warranted to validate these findings and establish definitive guidelines for pelvic lymph node irradiation in MIBC.
