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Radical Cystectomy Versus Trimodal Therapy for Muscle-Invasive Bladder Cancer

By: Julia Fiederlein
Posted: Friday, March 18, 2022

According to Alexandre R. Zlotta, MD, PhD, of Mount Sinai Hospital, Toronto, and colleagues, trimodal therapy consisting of maximal transurethral resection followed by concurrent chemoradiation appears to yield similar outcomes as treatment with radical cystectomy in patients with muscle-invasive bladder cancer. The results of this retrospective analysis, which were presented during the 2022 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium (Abstract 433), underscore the potential role of trimodal therapy as an alternative approach in this population.

The investigators focused on 703 patients with cT2–3/4a N0 M0 muscle-invasive bladder cancer who were eligible for both radical cystectomy and trimodal therapy; of this population, 421 underwent radical cystectomy, and 282 received trimodal therapy between 2005 and 2017 at the Massachusetts General Hospital, Princess Margaret Cancer Centre, or University of Southern California. The propensity score–matched analysis cohort comprised 1,116 patients (3:1 ratio; n = 834 radical cystectomy vs. 282 trimodal therapy).

The 5-year rates of metastasis-free (73% vs. 78%; P = .07), distant failure–free (78% vs. 82%; P = .14), and pelvic nodal failure–free (96% vs. 94%; P = .33) survival did not seem to differ between radical cystectomy and trimodality therapy; on the other hand, cancer-specific (78% vs. 85%; P = .02) and overall (70% vs. 78%; P < .001) survival appeared to favor trimodal therapy. According to the investigators, the outcomes of radical cystectomy and trimodal therapy did not differ among centers.

The final pathologic stage was T0 in 14%, T1 in 7%, T2 in 29%, and T3 or T4 in 42% of the patients who underwent radical cystectomy; node-positive disease was detected in 24% of this population. The rate of perioperative mortality with radical cystectomy was 2.1%, and the median number of nodes removed was 40. Non–muscle-invasive bladder cancer recurrence was reported in 20.5% of patients who received trimodal therapy.

Disclosure: For full disclosures of the study authors, visit

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