Login to Access Video or Poster Abstract: MP76-20
Sources of Funding: None

Introduction

The gold standard treatment for non-metastatic muscle invasive bladder urothelial carcinoma is radical cystectomy (RC) +/- neoadjuvant chemotherapy. Radiation therapy (RT) has typically been reserved for the adjuvant setting or in combination with chemotherapy when patients are medically unfit for extirpative surgery. The objective of this study was to assess factors associated with the use of RT in T2/T3 stage urothelial carcinomas and to identify utilization trends over time.

Methods

Patients ≥18 years of age diagnosed with AJCC stage T2/T3 bladder urothelial carcinoma were identified in the SEER database (1988-2012; n=41,448). These patients were categorized as those that received no RT, RT only, neoadjuvant RT, adjuvant RT, or both neo- and adjuvant RT. Temporal trends in utilization of RT were assessed in 5-year increments. Descriptive statistics and multivariable regression models were performed to generate odds ratios (OR) to identify factors associated with receipt of RT.

Results

There were 6,734 patients (16.2%) that received RT at any point in their treatment. Patients who were less likely to receive RT were younger (median age 72.2 years, no RT vs 76.8 years, RT only; p<0.001), Caucasian (no RT 84.0% vs 80.5% black; p<0.001) and married (no RT 84.6% vs 82.4% unmarried; p<0.001). Patients with T3 disease were less likely to receive only RT (7.4% vs 16.5% T2), however more likely to receive adjuvant RT (4.0% vs 0.8% T2; both p<0.001) compared to patients with T2 disease. Over time, the utilization of RT without extirpative surgery in the treatment of bladder urothelial carcinoma has increased (14.4% to 16.2%), however the utilization of adjuvant RT has declined (2.3% to 1.1%). Only 3.1% of patients that underwent RC received RT during any point in their treatment. The strongest factor associated with receipt of RT was T3 disease (vs T2 OR 1.89, 95%CI 1.73-2.05), in addition to Caucasian race (vs non-Caucasian OR 0.89, 95%CI 0.82-0.97), married status (vs unmarried OR 0.98, 95%CI 0.96-0.99), and RC (vs no RC 0.10, 95%CI 0.09-0.11).

Conclusions

The use of RT for patients with stage T2/T3 bladder urothelial carcinoma has increased modestly over the past 25-years, with more judicious use of RT in the adjuvant setting typically reserved for T3 disease. Furthermore, poor socioeconomic factors including non-Caucasian race and unmarried status may be associated with receipt of RT and warrants further specific evaluation.

Funding

None