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ASTRO 2022: Comparison of Trimodal Therapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer

By: Emily Rhode
Posted: Tuesday, November 8, 2022

The lack of level 1 data from randomized trials comparing bladder preservation with radical cystectomy for the treatment of muscle-invasive bladder cancer has led a team of researchers to perform a retrospective analysis of the outcomes of these two strategies. The multi-institutional matched cohort study was conducted by Jason A. Efstathiou, MD, PhD, FASTRO, of Harvard Medical School, Boston, and colleagues. Their findings were presented at the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 234).

The study initially consisted of 703 patients with stage T2–T3/4aN0M0 urothelial carcinoma of the bladder. Of them, 421 underwent radical cystectomy and 282 received trimodality therapy. Trimodality therapy consisted of complete transurethral resection of the bladder tumor followed by concurrent chemoradiotherapy. All patients had solitary tumors smaller than 7 cm, no or unilateral hydronephrosis, and no extensive carcinoma in situ.

Researchers then matched patients on a 3:1 basis with replacement therapy using treatment propensity scores. The matched cohort of 1,116 patients included 834 from the radical cystectomy group and 282 from the trimodality therapy group.

There was no significant difference between radical cystectomy (73%) and trimodality therapy (78%) when comparing the primary endpoint of metastasis-free survival (P = .07). Furthermore, no significant difference was observed between the groups for 5-year distant failure–free survival (78% and 83%, respectively; P = .14). Conversely, patients undergoing trimodality therapy had a slightly higher 5-year cancer-specific survival rate than those who had radical cystectomy (85% and 78%, respectively; P = .02). Overall survival rates also favored trimodality therapy over radical cystectomy (78% and 66%, respectively; P < .001).

“Oncologic outcomes seem to be equivalent between trimodality therapy and radical cystectomy, affirming the position that trimodality therapy should be offered as an effective alternative,” the authors concluded.

Disclosure: To view full disclosures for Dr. Efstathiou, visit

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