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Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation

PURPOSE: Chemoradiation (CRT) is a definitive treatment option for muscle-invasive bladder cancer (MIBC). Despite its effectiveness, CRT is underused, in part owing to concerns of tolerability and the need for integrated multidisciplinary care. We investigated factors associated with and the impact...

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Autores principales: Kotha, Nikhil V., Kumar, Abhishek, Nelson, Tyler J., Qiao, Edmund M., Qian, Alex S., Voora, Rohith S., McKay, Rana R., Stewart, Tyler F., Rose, Brent S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767252/
https://www.ncbi.nlm.nih.gov/pubmed/35071834
http://dx.doi.org/10.1016/j.adro.2021.100836
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author Kotha, Nikhil V.
Kumar, Abhishek
Nelson, Tyler J.
Qiao, Edmund M.
Qian, Alex S.
Voora, Rohith S.
McKay, Rana R.
Stewart, Tyler F.
Rose, Brent S.
author_facet Kotha, Nikhil V.
Kumar, Abhishek
Nelson, Tyler J.
Qiao, Edmund M.
Qian, Alex S.
Voora, Rohith S.
McKay, Rana R.
Stewart, Tyler F.
Rose, Brent S.
author_sort Kotha, Nikhil V.
collection PubMed
description PURPOSE: Chemoradiation (CRT) is a definitive treatment option for muscle-invasive bladder cancer (MIBC). Despite its effectiveness, CRT is underused, in part owing to concerns of tolerability and the need for integrated multidisciplinary care. We investigated factors associated with and the impact of treatment discontinuation in patients with MIBC treated with CRT. METHODS AND MATERIALS: In the US Veterans Affairs’ national database, we identified patients with urothelial histology, MIBC (T2-4a/N0-3/M0) diagnosed between 2000 and 2018 and treated with definitive-intent CRT. The primary endpoint of discontinued radiation was evaluated in a multivariable logistic regression. Secondary endpoints of 30-day and 90-day mortality, overall mortality, and nonbladder cancer mortality were evaluated in multivariable models. RESULTS: Of 369 veterans with MIBC who underwent CRT, 30 patients (8.1%) did not complete radiation. The most common reasons for treatment discontinuation included comorbidities or infections necessitating hospital admission (63.3%) and treatment intolerance or declining performance status (26.7%). In multivariable logistic regression, variables associated with radiation discontinuation were creatinine clearance ≤ 50 (odds ratio [OR], 3.93; 95% CI, 1.63-9.50; P = .002), incomplete transurethral resection of bladder tumor (TURBT) (OR, 3.16; 95% CI, 1.15-8.63; P = .02), and nonpreferred chemotherapy (OR, 3.31; 95% CI, 1.31-8.36; P = .01). In the cohort that discontinued radiation, 30-day mortality was 33.3% and 90-day mortality was 50.0%, with the majority of deaths attributed to nonbladder cancer causes. No patient or tumor variables were associated with either endpoint. In the cohort that completed radiation, 30-day mortality was 2.7% and 90-day mortality was 6.8%. In multivariable analysis, radiation discontinuation was associated with worse overall mortality (hazard ratio [HR], 2.48; 95% CI, 1.36-4.50; P = .003) and worse nonbladder cancer mortality (HR, 2.32; 95% CI, 1.24-4.34; P = .008). CONCLUSIONS: With a low rate of treatment discontinuation, CRT is an effective and feasible treatment option for the typically elderly and comorbid population of patients with MIBC. In addition to identified predictors of treatment discontinuation (poor renal function, incomplete TURBT, etc.), further research is required to develop evidence-based guidelines for optimal patient selection.
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spelling pubmed-87672522022-01-21 Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation Kotha, Nikhil V. Kumar, Abhishek Nelson, Tyler J. Qiao, Edmund M. Qian, Alex S. Voora, Rohith S. McKay, Rana R. Stewart, Tyler F. Rose, Brent S. Adv Radiat Oncol Scientific Article PURPOSE: Chemoradiation (CRT) is a definitive treatment option for muscle-invasive bladder cancer (MIBC). Despite its effectiveness, CRT is underused, in part owing to concerns of tolerability and the need for integrated multidisciplinary care. We investigated factors associated with and the impact of treatment discontinuation in patients with MIBC treated with CRT. METHODS AND MATERIALS: In the US Veterans Affairs’ national database, we identified patients with urothelial histology, MIBC (T2-4a/N0-3/M0) diagnosed between 2000 and 2018 and treated with definitive-intent CRT. The primary endpoint of discontinued radiation was evaluated in a multivariable logistic regression. Secondary endpoints of 30-day and 90-day mortality, overall mortality, and nonbladder cancer mortality were evaluated in multivariable models. RESULTS: Of 369 veterans with MIBC who underwent CRT, 30 patients (8.1%) did not complete radiation. The most common reasons for treatment discontinuation included comorbidities or infections necessitating hospital admission (63.3%) and treatment intolerance or declining performance status (26.7%). In multivariable logistic regression, variables associated with radiation discontinuation were creatinine clearance ≤ 50 (odds ratio [OR], 3.93; 95% CI, 1.63-9.50; P = .002), incomplete transurethral resection of bladder tumor (TURBT) (OR, 3.16; 95% CI, 1.15-8.63; P = .02), and nonpreferred chemotherapy (OR, 3.31; 95% CI, 1.31-8.36; P = .01). In the cohort that discontinued radiation, 30-day mortality was 33.3% and 90-day mortality was 50.0%, with the majority of deaths attributed to nonbladder cancer causes. No patient or tumor variables were associated with either endpoint. In the cohort that completed radiation, 30-day mortality was 2.7% and 90-day mortality was 6.8%. In multivariable analysis, radiation discontinuation was associated with worse overall mortality (hazard ratio [HR], 2.48; 95% CI, 1.36-4.50; P = .003) and worse nonbladder cancer mortality (HR, 2.32; 95% CI, 1.24-4.34; P = .008). CONCLUSIONS: With a low rate of treatment discontinuation, CRT is an effective and feasible treatment option for the typically elderly and comorbid population of patients with MIBC. In addition to identified predictors of treatment discontinuation (poor renal function, incomplete TURBT, etc.), further research is required to develop evidence-based guidelines for optimal patient selection. Elsevier 2021-10-25 /pmc/articles/PMC8767252/ /pubmed/35071834 http://dx.doi.org/10.1016/j.adro.2021.100836 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Scientific Article
Kotha, Nikhil V.
Kumar, Abhishek
Nelson, Tyler J.
Qiao, Edmund M.
Qian, Alex S.
Voora, Rohith S.
McKay, Rana R.
Stewart, Tyler F.
Rose, Brent S.
Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation
title Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation
title_full Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation
title_fullStr Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation
title_full_unstemmed Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation
title_short Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation
title_sort treatment discontinuation in patients with muscle-invasive bladder cancer undergoing chemoradiation
topic Scientific Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767252/
https://www.ncbi.nlm.nih.gov/pubmed/35071834
http://dx.doi.org/10.1016/j.adro.2021.100836
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