RTOG Pooled Analysis Shows Good Long-Term Outcomes After Bladder-Preserving Combined-Modality Therapy for Muscle-Invasive Bladder Cancer
In a pooled analysis of prospective Radiation Therapy Oncology Group (RTOG) studies reported in the Journal of Clinical Oncology, Mak et al found good long-term outcomes with bladder-preserving combined-modality therapy for muscle-invasive bladder cancer.
Study Details
The analysis included 468 patients enrolled in five phase II studies (RTOG 8802, 9506, 9706, 9906, 0233) and one phase III study (RTOG 8903) assessing combined-modality therapy in muscle-invasive bladder cancer in which cystectomy was reserved for salvage treatment. Study enrollment occurred between 1988 and 2007. Patients had a median age of 66 years (range = 34–93 years), and clinical T stage was T2 in 61%, T3 in 35%, and T4a in 4%.
Long-Term Outcomes
Complete response to combined-modality therapy occurred in 69% of patients. Median follow-up was 4.3 years among all patients and 7.8 years among survivors (n = 205). The 5- and 10-year overall survival rates were 57% and 36%, and the 5- and 10-year disease-specific survival rates were 71% and 65%. The 5- and 10-year rates were 13% and 14% for muscle-invasive local failure, 31% and 36% for non–muscle-invasive local failure, and 31% and 35% for distant metastases.
In the 21% of patients requiring salvage cystectomy for nonresponse to combined-modality therapy or disease recurrence, 5- and 10-year overall survival rates were 45% and 18% and 5- and 10-year disease-specific survival rates were 60% and 47%.
The investigators concluded: This pooled analysis of multicenter, prospective RTOG bladder-preserving [combined-modality] protocols demonstrates long-term [disease-specific survival] comparable to modern immediate cystectomy studies, for patients with similarly staged [muscle-invasive bladder cancer]. Given the low incidence of late recurrences with long-term follow-up, [combined-modality therapy] can be considered as an alternative to radical cystectomy, especially in elderly patients not well suited for surgery.”
Raymond H. Mak, MD, of Brigham and Women’s Hospital/Dana-Farber Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the RTOG and National Cancer Institute. For full disclosures of the study authors, visit jco.ascopubs.org.
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