Abstract 286P
Background
To examine the survival outcomes of radiotherapy in patients with bladder cancer (BC) who are unfit for cystectomy and to investigate associated prognostic factors.
Methods
A retrospective cohort study was conducted at two hospitals, including patients diagnosed with stage 0-IV bladder cancer who were unfit for cystectomy and received radiotherapy between January 1, 2000, and December 31, 2022. Overall survival (OS) was compared by cancer stage and prescribed radiation dose. For patients with stage II-III BC receiving radical radiotherapy (≥60 Gy), OS was analyzed in relation to prognostic factors such as age (≥80 years), prophylactic pelvic irradiation, the presence of hydronephrosis, and the combination of chemotherapy using Kaplan-Meier plots and log-rank tests. Cox proportional hazards regression analysis was conducted to identify factors affecting OS.
Results
A total of 507 patients met the eligibility criteria. The median age was 77 years (range: 39-101), 362 (71.4%) were male, and 97 (19.1%) had a performance status of 2-4. A subset of 304 patients with stages II-III BC received radical radiotherapy doses of 60-70 Gy. Median OS for patients with Ta-1N0M0, T2N0M0, T3-4N0M0, N1-3M0, and M1 disease were 31, 26, 27, 14, and 9 months, respectively. Distant metastases at diagnosis were associated with poorer OS (p<0.001), while regional lymph node metastasis was not (p=0.194). Median OS extended to 4, 15, 15, 25, and 26 months for radiation doses of <30, 30-45, 45-60, 60-65, and >65 Gy, respectively. In patients receiving radical radiotherapy, the median OS was 29 months. Patients with hydronephrosis had a significantly shorter median OS of 16 months (95% CI: 12-26) compared to 38 months (95% CI: 30-48) in those without (p<0.001). Age (P=0.902), prophylactic pelvic irradiation (P=0.065), and concurrent chemotherapy (P=0.223) did not significantly affect OS. Hydronephrosis was identified as the only independent factor significantly correlated with OS (hazard ratio [HR]: 0.531, p=0.001).
Conclusions
Radiotherapy is a viable option for bladder cancer patients unfit for cystectomy. Hydronephrosis has a negative impact on survival outcomes but does not contraindicate radiotherapy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.