Bladder-Sparing Trimodal Therapy vs Radical Cystectomy in Patients With Clinically Node-Positive Nonmetastatic Bladder Cancer

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In a retrospective study reported in the Journal of Clinical Oncology, Swinton et al found that bladder-sparing trimodal therapy with radical-dose radiotherapy was an effective alternative to radical cystectomy in patients with clinically node-positive nonmetastatic bladder cancer.

As stated by the investigators, “Bladder-sparing trimodal therapy is an alternative to radical cystectomy according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer…. We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice.”

Study Details

The study included data from 287 patients diagnosed with cN1, M0 disease between 2012 and 2021 at four centers in the United Kingdom that offered both trimodal therapy and radical cystectomy. The primary outcome measures were overall and progression-free survival.

Key Findings

Median overall survival among all patients was 1.55 years, with rates at 2 and 5 years of 39% and 19%. Median progression-free survival was 0.95 years, with rates at 2 and 5 years of 28% and 17%.

Radical treatment was received by 163 patients and palliative treatment was received by 124. Radical treatment was associated with better overall survival (median = 2.4 vs 0.89 years, hazard ratio [HR] = 0.32, 95% confidence interval [CI] = 0.23–0.44, P < .001), as well as better progression-free survival (median = 1.5 vs 0.63 years, HR = 0.36, 95% CI = 0.27–0.46, P < .001).

Among patients receiving radical treatment, 87 received radical-dose radiotherapy and 76 underwent radical cystectomy, with choice of radical treatment having no significant impact on survival outcomes on multivariate analysis. For radical-dose radiotherapy vs radical cystectomy, median overall survival was 2.53 years vs 2.09 years (HR = 0.94, 95% CI = 0.63–1.41, P = .76), with 2-year rates of 60% vs 51%, and median progression-free survival was 1.93 years vs 1.22 years (HR = 0.74, 95% CI = 0.50–1.08, P = .12). 

The investigators concluded, “Patient cohorts with cN1, M0 bladder cancer had equivalent survival outcomes whether treated with surgery or radical radiotherapy. Given the known morbidities of radical cystectomy—in a patient group with poor survival—this study confirms that bladder-sparing trimodal therapy treatment should be a treatment option available to all patients with cN1, M0 bladder cancer.”

Martin Swinton, MBBChir, of the Christie Hospital NHS Foundation Trust, Manchester, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Cancer Research UK RadNet Manchester, Prostate Cancer UK, Movember Foundation, and others. For full disclosures of the study authors, visit

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