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...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109421001949 |
| _version_ | 1811191512644452352 |
|---|---|
| author | Nikhil V. Kotha, BS Abhishek Kumar, MD, MAS Tyler J. Nelson, BS Edmund M. Qiao, BS Alex S. Qian, BS Rohith S. Voora, BS Rana R. McKay, MD Tyler F. Stewart, MD Brent S. Rose, MD |
| author_facet | Nikhil V. Kotha, BS Abhishek Kumar, MD, MAS Tyler J. Nelson, BS Edmund M. Qiao, BS Alex S. Qian, BS Rohith S. Voora, BS Rana R. McKay, MD Tyler F. Stewart, MD Brent S. Rose, MD |
| author_sort | Nikhil V. Kotha, BS |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-11T15:07:06Z |
| format | Article |
| id | doaj.art-4ed408615f0f4553b63df4b69afacd4b |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-11T15:07:06Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-4ed408615f0f4553b63df4b69afacd4b2022-12-22T04:16:46ZengElsevierAdvances in Radiation Oncology2452-10942022-01-0171100836Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing ChemoradiationNikhil V. Kotha, BS0Abhishek Kumar, MD, MAS1Tyler J. Nelson, BS2Edmund M. Qiao, BS3Alex S. Qian, BS4Rohith S. Voora, BS5Rana R. McKay, MD6Tyler F. Stewart, MD7Brent S. Rose, MD8Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, California; Corresponding author: Nikhil V. Kotha, BSVeterans Affairs San Diego Healthcare System, San Diego, California; Department of Radiation Oncology, Duke University, Durham, North CarolinaDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, CaliforniaDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, CaliforniaDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, CaliforniaDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, CaliforniaDivision of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, California; Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CaliforniaDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, CaliforniaPurpose: 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.http://www.sciencedirect.com/science/article/pii/S2452109421001949 |
| spellingShingle | Nikhil V. Kotha, BS Abhishek Kumar, MD, MAS Tyler J. Nelson, BS Edmund M. Qiao, BS Alex S. Qian, BS Rohith S. Voora, BS Rana R. McKay, MD Tyler F. Stewart, MD Brent S. Rose, MD Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation Advances in Radiation Oncology |
| 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 |
| url | http://www.sciencedirect.com/science/article/pii/S2452109421001949 |
| work_keys_str_mv | AT nikhilvkothabs treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT abhishekkumarmdmas treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT tylerjnelsonbs treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT edmundmqiaobs treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT alexsqianbs treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT rohithsvoorabs treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT ranarmckaymd treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT tylerfstewartmd treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation AT brentsrosemd treatmentdiscontinuationinpatientswithmuscleinvasivebladdercancerundergoingchemoradiation |