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Management of muscle-invasive bladder cancer during a pandemic: Impact of treatment delay on survival outcomes for patients treated with definitive concurrent chemoradiation

ABSTRACT: Abstract: Introduction During the COVID-19 pandemic, providers and patients must engage in shared decision-making to ensure that the benefit of early intervention for muscle-invasive bladder cancer (MIBC) exceeds the risk of contracting COVID-19 in the clinic setting. It is unknown whether treatment delays for MIBC patients eligible for curative chemoradiation (CRT) compromise long-term outcomes. Patients and Methods In this study, we used the National Cancer Database to investigate if there is an association between a ?90-day delay from TURBT in initiating CRT and overall survival (OS). We included patients with cT2-4N0M0 MIBC from 2004-2015 who underwent TURBT and curative-intent concurrent CRT. Patients were grouped based on timing of CRT: ?89 days after TURBT (‘earlier’) vs. ? 90 & <180 days after TURBT (‘delayed’). Results 1,387 (87.5%) received ‘earlier’ CRT (median 45 days post-TURBT, IQR: 34-59 days) and 197 (12.5%) received ‘delayed’ CRT (median 111 days post-TURBT, IQR: 98-130 days). Median OS was 29.0 months (95% CI, 26.0-32.0) versus 27.0 months (95% CI, 19.75-34.24) for ‘earlier’ and ‘delayed’ CRT, respectively (p=0.94). On multivariable analysis, delayed CRT was not associated with an OS difference: hazard ratio, 1.05 (95% CI, 0.87-1.27); p=0.60. Conclusion While these results are limited and require validation, short strategic treatment delays during a pandemic can be considered based on clinician judgement.

SUBMITTER: Fischer-Valuck B

PROVIDER: S-EPMC7306737 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Project description:BackgroundConcurrent chemoradiotherapy (CRT) as a definitive treatment option for patients with nonmetastatic muscle-invasive bladder carcinoma (MIBC) is increasingly being applied in clinical practice.ObjectiveTo assess the oncological and toxicity outcomes in a contemporary cohort of nonmetastatic MIBC patients treated with concurrent CRT in daily practice.Design setting and participantsPatients with nonmetastatic MIBC (cT2-4aN0M0) who had received CRT with curative intent between January 2010 and April 2020 in three centers were retrospectively identified. The CRT consisted of 66 Gy (or biologically equivalent) plus either mitomycin C and fluorouracil/capecitabine or cisplatinum.Outcome measurements and statistical analysisThe primary endpoint was the 2-yr locoregional disease-free survival (LDFS) estimate. Secondary endpoints were complete response, disease-specific survival (DSS), overall survival (OS), bladder intact event-free survival (BI-EFS), and severe adverse events (<90 d of starting CRT). Kaplan-Meier survival and Cox multivariable regression analyses were performed.Results and limitationsWe included data of 240 MIBC patients with a median age of 74 yr and a median follow-up of 27 mo (interquartile range 11-44). Complete response on first cystoscopy after CRT was seen in 209 cases (90%). The 2-yr LDFS was 76% (95% confidence interval [CI] 70-82%); the 5-yr OS and DSS were 50% (95% CI 42-59%) and 70% (95% CI 62-79%), respectively. On multivariable analysis, cT2 versus cT3-4 tumor stage was significantly associated with better DSS (hazard ratio 1.02, 95% CI 1-1.05, p = 0.024). The 2-yr BI-EFS was 75% (95% CI 69-82%). Forty-three (17%) patients experienced a severe adverse event (grade ≥3). Limitations include retrospective design and heterogeneous administration of CRT.ConclusionsConcurrent CRT is a safe and effective treatment modality for nonmetastatic MIBC.Patient summaryChemoradiotherapy for the treatment of muscle-invasive bladder carcinoma is increasingly being applied. In this study, we reviewed the outcomes of this bladder-sparing treatment using a series of patients treated in three hospitals in daily practice. We found that administration of chemoradiotherapy can be safe and effective.

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Management of muscle-invasive bladder cancer during a pandemic: Impact of treatment delay on survival outcomes for patients treated with definitive concurrent chemoradiation

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