PD41-01 NATIONAL PRACTICE PATTERNS AND OUTCOMES FOR ADJUVANT RADIOTHERAPY AFTER RADICAL CYSTECTOMY FOR UROTHELIAL BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2018PD41-01 NATIONAL PRACTICE PATTERNS AND OUTCOMES FOR ADJUVANT RADIOTHERAPY AFTER RADICAL CYSTECTOMY FOR UROTHELIAL BLADDER CANCER Zhoobin Bateni, Shane Pearce, Daniel Zainfeld, Leslie Ballas, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Zhoobin BateniZhoobin Bateni More articles by this author , Shane PearceShane Pearce More articles by this author , Daniel ZainfeldDaniel Zainfeld More articles by this author , Leslie BallasLeslie Ballas More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1940AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adjuvant radiation therapy (ART) after radical cystectomy (RC) for urothelial bladder cancer (UBC) may play a role in the management of muscle-invasive bladder cancer, particularly in patients with locally advanced disease and adverse pathologic features (pT3/4 or positive surgical margins [PSMs]). Unfortunately, evidence supporting an overall survival (OS) benefit for ART is lacking. We sought to evaluate national practice patterns for the use of ART and assess its impact on OS for patients with adverse pathologic features after RC. METHODS The National Cancer Database queried (2004 to 2013) for patients with urothelial cell carcinoma (pure or variant) and adverse pathologic features after RC (n=19,949), excluding patients with pN3 or metastatic disease. Patients were divided into 2 treatment groups: RC alone (n=18,811) and RC with ART (n=408) defined as a minimum 45 Gy to the pelvis within 180 days after RC. Predictors of receiving ART were identified with multivariable logistic regression. Multivariable Cox proportional hazards model was used to assess the impact of ART on OS. RESULTS Use of ART has decreased during the study period from 3.1% in 2004 to 1.6% in 2013 (p=0.002). ART was administered in 1.3%, 4.0% and 5.1% of patients with pT3, pT4, and PSMs (any pT stage), respectively. On univariate analysis, use of ART was associated with younger age, female sex, low-volume hospitals, non-academic community care centers, higher stages, PSMs, perioperative chemotherapy, and lymph node-positive disease (all p<.001). Predictors of receiving ART on multivariable analysis include PSMs [RR:3.4 (95%CI, 2.5-4.6); p<.0001], pT4 [RR:2.6 (95%CI, 1.1-6.2); P=0.02], community based centers [RR:2.1 (95%CI, 1.5-3.0); p<.0001], and female sex [RR:1.8 (95%CI, 1.4-2.4); p<.0001]. Unadjusted 5-years OS was 27% 0.4 in RC alone vs 18% 2.2 RC with ART (p=0.02). On multivariate Cox regression analysis, ART was not independently associated with OS in the full cohort (p=0.15). However, Subgroup analysis showed an OS benefit for ART among patients with PSMs [HR:0.82 (95%CI, 0.68-0.98); P=0.03]. CONCLUSIONS Use of ART following RC for adverse pathologic features is not commonly performed in the United States and rates of ART is decreasing over time. ART may improve overall survival for the patients with PSMs. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e809 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zhoobin Bateni More articles by this author Shane Pearce More articles by this author Daniel Zainfeld More articles by this author Leslie Ballas More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...