Does Prior Pelvic Radiation Therapy Impact on Outcomes of Patients with Bladder Cancer?

Patients who received prior pelvic radiation (XRT) for prostate cancer are at higher risk of developing secondary bladder cancers (SBCs). It was thought that radiation-induced SBCs would lead to a more aggressive phenotype and worse clinical outcomes than primary bladder cancers. However, comparisons with properly matched cohorts have been lacking.

A recently published study by Murthy et al. in Urologic Oncology investigated the impact of prior pelvic XRT on outcomes following radical cystectomy for patients with SBCs. This is particularly relevant because these patients are less likely to be candidates for trimodal therapy due to cumulative radiation toxicity. The authors applied propensity score matching to balance the baseline characteristics of 984 patients with a history of prior XRT for prostate cancer to those without radiation history (no XRT). The following variables were used for matching age, preoperative chronic kidney disease status, nutritional deficiency, neoadjuvant cisplatin-based chemotherapy use, Charlson comorbidity index assignment, surgical approach, urinary diversion type, and pathologic T-stage. This yielded a total of 227 patients eligible for the final analysis, including 47 patients in the prior XRT group.

The authors found no significant differences in the perioperative outcomes, including operative time, length of stay, and 90-day complication and mortality rates. The downstaging to pT0 and the presence of variant histology were similar in the prior-XRT to the no XRT groups (31% vs. 29%, P = 0.86 and 19% vs. 21%, P = 0.77, respectively). Finally, survival outcomes, including recurrence-free and overall survival, did not show significant differences between the two groups.

This single-institution assessment is encouraging results for SBC patients from prior XRT undergoing radical cystectomy. However, the long interval between prior pelvic radiotherapy and SBC diagnosis potentially dampens the radiation effects. Patients with prior XRT should receive the standard of care radical surgery as those previously treated with XRT.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

References:

Murthy PB, Lone Z, Corrigan D, Campbell R, Munoz-Lopez C, Caveney M, et al. Survival outcomes following radical cystectomy in patients with prior pelvic radiation for prostate cancer: A matched cohort analysis. Urol Oncol. 2021;doi.10.1016/j.urolonc.2021.06.017.

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