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Thomas Flaig, MD


ASTRO 2022: Adding Pelvic Lymph Node Treatment to Bladder-Sparing Chemoradiotherapy for Bladder Cancer

By: Julia Fiederlein
Posted: Tuesday, November 1, 2022

Data are limited regarding whether the addition of pelvic lymph node treatment may impact outcomes in patients with muscle-invasive bladder cancer undergoing bladder-sparing chemoradiotherapy. The results of a retrospective analysis, which were presented by Sagar Anil Patel, MD, of the Winship Cancer Institute of Emory University, Atlanta, and colleagues during the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 235), suggested that routine inclusion may not be necessary in those with node-negative disease.

Using the National Cancer Database, the investigators identified patients with cT2–T4 N0 M0 disease who underwent maximal transurethral resection of a bladder tumor prior to treatment with definitive-intent chemoradiation therapy of the bladder alone (n = 719) or the bladder plus pelvic lymph nodes (n = 1,847). In both groups, the median radiation dose to the bladder was 64.8 Gy; the median radiation dose to the pelvic nodes was 45.0 Gy.

The percentage of patients receiving pelvic nodal treatment increased from 65.4% in 2004 to 76.8% in 2016 (P < .0001 for trend). With a median follow-up of 6.2 years, the 5-year (bladder alone: 28.4%; bladder plus pelvic lymph nodes: 31.9%) and 10-year (bladder alone: 11.5%; bladder plus pelvic lymph nodes: 14.0%) overall survival outcomes did not seem to significantly differ between the groups (log-rank P = .19). Based on a multivariable analysis, there was no significant association between pelvic nodal coverage and overall survival (adjusted hazard ratio = 0.93; P = .17). No differential effect by T stage was reported (T3–4 vs. T2: interaction P = .41). According to the investigators, future prospective studies with adverse event, quality-of-life, and cancer-specific endpoints are warranted.

Disclosure: Dr. Patel reported no conflicts of interest.

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