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Pelvic Radiotherapy Combined With Chemotherapy in Metastatic Urothelial Cancer

By: Kelly M. Hennessey, PhD
Posted: Tuesday, January 12, 2021

Few studies have examined the benefit of local radiotherapy for patients with metastatic urothelial cancer. Benjamin Fischer-Valuck, MD, of the Winship Cancer Institute of Emory University, Atlanta, and colleagues found that adding high-dose pelvic radiotherapy locally to the bladder plus chemotherapy improved overall survival in patients with metastatic urothelial cancer compared with chemotherapy alone. These results were presented during the 2020 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 4123) and published in the International Journal of Radiation Oncology • Biology • Physics.

“The findings are hypothesis-generating; a prospective trial evaluating the impact of bladder radiotherapy in metastatic urothelial cancer is warranted,” commented the investigator.

The research team conducted a large retrospective analysis of the National Cancer Database of patients with newly diagnosed metastatic urothelial cancer. They identified a total of 3,289 patients who fit the inclusion criteria. Of the total, 229 patients received chemotherapy plus high-dose pelvic radiotherapy to the bladder, and 3,060 received chemotherapy alone. Patients who received partial, total, or radical cystectomy were excluded. The use of radiotherapy related to advanced age, higher T stage, and treatment was administered at a nonacademic facility.

Pelvic radiotherapy was independently associated with improved overall survival, whereas advanced age, higher T stage, and comorbidity score correlated with worse overall survival. Propensity analysis matched 229 patients who had received radiotherapy plus chemotherapy with 229 patients who received chemotherapy alone. Median overall survival with radiotherapy plus chemotherapy was 14.5 months compared with 10. 5 months with chemotherapy alone. The median follow-up was 10.9 months. Landmark analysis conducted at ≥ 6 months estimated that patients who received radiotherapy plus chemotherapy experienced median overall survival of 17.0 months versus 13.8 months for those given chemotherapy alone; at ≥ 12 months, median overall survival was 24.2 months versus 17.1 months, respectively.

Disclosure: For full disclosures of the study authors, visit redjournal.org.



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