International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationA 10-Year Retrospective Review of a Nonrandomized Cohort of 458 Patients Undergoing Radical Radiotherapy or Cystectomy in Yorkshire, UK
Introduction
Bladder cancer remains a significant health problem in the United Kingdom, accounting for 4,734 deaths in 2005 (1). The optimal treatment for muscle-invasive transitional carcinoma is still open to debate. Historically, radical treatment options for transitional cell carcinoma (TCC) constituted surgery, which was favored in the United States, whereas many centers in Europe (particularly the U.K.) reserved surgery for cases in which radical external beam radiotherapy (RT) had been unsuccessful. Current European Urological Association guidelines suggest that RT alone should be considered as a therapeutic option only in patients unfit for radical cystectomy, with multimodality transurethral resection of the bladder tumor, RT, and chemotherapy regimens an option (2). However, randomized or controlled studies examining the efficacy of treatments for invasive bladder cancer are scarce, so such recommendations are not based on high-quality evidence.
In 2003, we reported on the mortality, morbidity, and 5-year survival of 458 patients who underwent radical RT and/or surgery for invasive bladder cancer in Yorkshire between 1993 and 1996 (3), and we have continued surveillance of this cohort for a further 5 years.
The aim of this study was to present the survival of these patients 10 years after their primary treatment. The primary outcome measure was all-cause mortality, recorded by the Northern and Yorkshire Cancer Registry and Information Service (NYCRIS). In addition, we repeated proportional hazards regression modeling to identify patient, disease, and treatment parameters that correlate with the likelihood of 10-year survival.
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Methods and Materials
The patient cohort has been described in detail previously (3). NYCRIS is a population-based cancer registry collecting data on all cancers in the Northern and Yorkshire areas of England. From the NCYRIS database, all bladder cancer patients who were treated with RT or radical cystectomy between 1993 and 1996 were identified. NYCRIS identified 348 patients who had undergone radical RT. Survival data were available for 347 patients, and casenotes were reviewed in 302. Similarly, 110 patients
Results
The patient details are shown in Table 1. The mean age for those undergoing surgery was 5 years younger than for those undergoing RT. The American Society of Anesthesiologists (ASA) grades taken from the initial endoscopic resection were similar in both treatment groups, but a preponderance of neurologic, cardiac, and respiratory problems were seen in those receiving RT.
The tumors were clinically staged according to the 1987 TNM classification. Cross-sectional computed tomography/magnetic
Discussion
Evidence from controlled clinical trials is sparse to inform treatment choices for invasive bladder cancer. In this environment we chose to investigate the outcome of radical TCC treatments in a large but defined area of the U.K. Our first paper, published in 2003 in European Urology, looked at 5-year survival, factors predicting survival, and perioperative mortality and morbidity for a cohort of 458 patients undergoing primary treatment between 1993 and 1996 (3). We were unable to demonstrate
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Cited by (61)
Myths About Bladder Preservation in Muscle-Invasive Bladder Cancer
2023, Seminars in Radiation OncologyTreatment of muscle-invasive bladder cancer in patients without comorbidities and fit for surgery: Trimodality therapy vs radical cystectomy. Development of GRADE (Grades of Recommendation, Assessment, Development and Evaluation) recommendation by the Italian Association of Radiotherapy and Clinical Oncology (AIRO)
2021, Critical Reviews in Oncology/HematologyCitation Excerpt :Results showed higher mortality rate for patients in the RC group (15 vs 3.3 %, respectively). Of note, direct applicability of these results to patients undergoing TMT is uncertain, considering that patients in this series were not treated with concomitant CT (Munro et al., 2010). The literature search returned 210 records after duplicates removal.
Treatment Allocation and Survival in Patients Diagnosed with Nonmetastatic Muscle-invasive Bladder Cancer: An Analysis of a National Patient Cohort in England
2021, European Urology FocusCitation Excerpt :One-third of patients have nonmetastatic muscle-invasive bladder cancer (MIBC) at diagnosis—a potentially curable disease. There is an absence of randomised controlled-trial data comparing radical cystectomy (RC) with radical radiotherapy (RT), although the available comparative data suggest survival equivalence [5,6]. The difficulty in obtaining randomised data describing radical treatment is highlighted by the closure of the feasibility phase of the UK-led SPARE study, a phase III study intended to compare survival after RC with radical RT [7].
Conflict of interest: none.