Bladder-Sparing Treatment With Radical Dose Radiotherapy Is an Effective Alternative to Radical Cystectomy in Patients With Clinically Node-Positive Nonmetastatic Bladder Cancer

Author(s): Martin Swinton, MBBChir1,2; Neethu Billy Graham Mariam, MBChB1; Jean Ling Tan, MBChB2; Katherine Murphy, MBChB3; Thiraviyam Elumalai, MD4; Manjusha Soni, MBBS, MD5; Alexandra Ferrera, MBChB1; Charlotte Richardson, MBChB5; Richard Walshaw, MBChB, PhD3; Hitesh Mistry, PhD2; Vijay Ramani, MBBS1; Yeepei Song, MBBCh, MD1; Alison Birtle, MBBS, MD6; Ann Henry, MBChB, MD5; Joachim Chan, MBBS, MD3; Peter Hoskin, MD2; and Ananya Choudhury, MA, PhD1,2
Source: DOI: 10.1200/JCO.23.00725 Journal of Clinical Oncology 41, no. 27 (September 20, 2023) 4406-4415.
Anjan J Patel MD

Dr. Anjan Patel's Thoughts

The poor OS of 1.5 years in node-positive patients is striking in this retrospective review of 287 patients treated with definitive intent. The OS was not different between those treated with TURBT + chemoradiation vs. chemotherapy + radical cystectomy, suggesting that surgery may not be superior to multi-modal therapy and QOL may be superior in a non-operative approach.


Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa). We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice.


Data from patients diagnosed with cN+ M0 BCa were collected from participating UK Oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors.


A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI, 1.35 to 1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23 to 0.44; P < .001) compared with receiving palliative treatment. Radically treated patients (n = 163) received RC (n = 76) or radical dose radiotherapy (RT, n = 87); choice of radical treatment showed no association with OS (HR, 0.94; 95% CI, 0.63 to 1.41; P = .76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P = .12) on multivariable analysis.


Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC—in a patient group with poor survival—this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.

Author Affiliations

1Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; 2University of Manchester, Manchester, United Kingdom; 3Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom; 4Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; 5Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 6Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom

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