The efficacy of trimodality bladder-sparing treatment in bladder cancer

Abstract

16006 Background: Bladder-sparing trimodality therapy utilizing transurethral resection of the bladder tumor (TURBT), radiation and chemotherapy has become an important alternative to radical cystectomy in patients with invasive bladder cancer. Many single-arm studies report that trimodality therapy is effective, and its outcome may be comparable to radical cystectomy. We have conducted a meta-analysis of these studies to better evaluate the overall efficacy of bladder-sparing therapy in comparison with radical cystectomy. Methods: We searched Pubmed database for the past twenty years and abstracts from the American Society of Clinical Oncology Annual Meetings for the past three years to identify relevant studies. Eligible trimodality bladder-sparing studies included TURBT combined with the institution's chosen protocol of radiation and chemotherapy and clinical trials. Eligible radical cystectomy studies included three major surgical series. The summary complete response (CR), 5-year overall survival rates, and the 5-year survival rate with intact bladder were calculated using the random-effects or the fixed-effects model based on the heterogeneity of studies. Results: A total of 1211 patients in 10 studies with trimodality therapy were included for analysis. The summary CR rate was 67.0% (95% CI: 59.3–73.9%). Among patients with data available, the summary 5-year overall survival rate was 51.6% (95% CI: 46.8–56.5%), while the summary 5-year survival rate with intact bladder was 43.1% (95% CI: 39.8–46.5%). A total of 1250 patients in 3 major studies with radical cystectomy were included for analysis. The summary 5-year overall survival rate was 59.6% (95% CI: 56.9–62.3%). Interestingly, a comparison of the 5-year overall survival rates of the two approaches showed a significant difference with a risk ratio of 86.6% (95% CI: 80.4- 93.3%, p<0.001) in favor of radical cystectomy. Conclusions: Trimodality bladder-sparing therapy is a valuable alternative to radical cystectomy in selected patients with invasive bladder cancer. Favorable 5-year overall survival may be associated with cystectomy instead of the bladder-sparing approach. Radical cystectomy remains the standard of care for invasive bladder cancer. No significant financial relationships to disclose.