Intra-arterial Chemotherapy Plus Radiotherapy Versus Cystectomy for Patients With MIBC

Intra-arterial chemotherapy combined with radiotherapy (IAC-RT) may be a useful and tolerable treatment option for patients with muscle-invasive bladder cancer (MIBC) who are unfit for radical cystectomy, according to new research presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium.

While radical cystectomy has been considered a standard-of-care option for patients with MIBC, some patients are unfit for this procedure or refuse it. IAC-RT is a bladder-preserving option for these patients, but limited data exist in patients who received IAC-RT without salvage radical cystectomy.

Ikko Tomisaki, MD, PhD, and colleagues sought to evaluate the efficacy and tolerability of IAC-RT without radical cystectomy compared with radical cystectomy alone in patients with MIBC. A total of 42 patients and 143 patients received IAC-RT and RC, respectively, for MIBC (T2-4N0M0) at their hospital between January 1999 and December 2019. The retrospective review considered overall survival (OS), disease-specific survival (DSS), and metastasis-free survival (MFS) for all patients.

Among the patients who received IAC-RT, 67% (n=28) and 33% (n=14) refused radical cystectomy and imperative cases, respectively. Compared with the patients who underwent radical cystectomy, patients who underwent IAC-RT tended to be older (median age, 77 years vs 69 years), had poorer performance status (≥2, 43.0% vs 4.9%), and had shorter follow-up time (median, 21.9 months vs 40.0 months).

Results of the analysis showed median OS was 38.7 months (95% CI, 16.9-74.7) with IAC-RT compared with 154.0 months (95% CI, 70.6-not estimable) with radical cystectomy. Researchers noted these OS curves were significantly different (P=.001).

No significant differences were reported between the 2 groups in terms of DSS (median, 46.5 months vs not reached; P=.06) and MFS (median, 38.7 months vs not reached; P=.21).

Furthermore, researchers found that while grade 3 adverse events occurred in 50% (n=21) of patients with IAC-RT, most of them were hematologic adverse events. No grade 4/5 adverse events were observed.

These results led researchers to conclude that IAC-RT is an effective and tolerable treatment option for patients with MIBC who are unfit or refuse radical cystectomy.