Introduction:

Although radical cystectomy (RC) has remained a mainstay for management of cT2-3 urothelial carcinoma (UC), contemporary evidence indicates that bladder-preserving trimodal therapy (TMT) may offer similar oncologic outcomes in select patients with muscle-invasive bladder cancer (MIBC). Traditionally reserved for patients unsuitable for surgical intervention, the significant morbidity and mortality linked to RC have led to a growing adaptation of TMT as a viable and effective alternative for definitive treatment with curative intent. In this study, we aim to present our institutional experience with TMT in a racially diverse population.  

Methods:

A single-center retrospective cohort study was performed to identify all patients who underwent radiation therapy (RT) for MIBC (cT2-T3) UC from 2012-2021 at our institution. All patients who underwent RT with or without concurrent chemotherapy with curative intent after diagnostic TUBT, with or without re-staging TURBT were included. Patient demographic (age, sex, race) and clinicopathologic data (stage, presence of hydronephrosis, concurrent carcinoma in-situ (CIS)) were extracted from the medical record.  Primary outcomes were response to TMT (complete response [CR], partial response [PR], progression) and recurrence-free and overall survival. Response was determined based on the first surveillance imaging, cystoscopy, or TURBT after completion of TMT. 

Results:

47 patients underwent TMT with radiation therapy performed at our institution during the study period. One patient was excluded from the analysis due to primary oncologic care at an outside hospital with records not available for review. 39.1% were Latino/Hispanic, 19.6% of patients were Black/Non-Hispanic, and 26.1% were White/Non-Hispanic. 47.8% were female and 91.3% underwent concurrent chemotherapy with RT. 32 (69.6%), 9 (19.6%), and 5 (10.9%) patients experienced CR, PR and progression after TMT, respectively (Table 1). Median and mean follow-up times were 25.8 and 40.4 months, respectively. Overall, 27 (58.7%) patients were disease-free at the time of last follow-up, of which 74.1% were still alive. Of those alive at last follow-up, 97.0% had an intact bladder. 13 were alive with disease (28.3%) and 7 (15.2%) were deceased with disease.  

Conclusion:

With a recent growing body of evidence supporting TMT as a viable alternative to RC as definitive management for MIBC in select patients, we report our institutional experience describing outcomes over a 2-year follow-up period. In concordance with prior reports, TMT offers favorable tumor response rates for patients seeking definitive therapy for cT2-3UC. Extended follow-up is needed to assess the durability of response and long-term survival after TMT. 

Funding: N/A