ESTRO 2024 - Abstract Book

S2355

Clinical - Urology

ESTRO 2024

Oncology, Liverpool, United Kingdom. 11 Royal Devon University Healthcare NHS Foundation Trust, Department of Oncology, Exeter, United Kingdom

Purpose/Objective:

There is no randomised comparison of outcomes following radical radiotherapy and surgery for muscle invasive bladder cancer (MIBC). One randomised study closed early due to poor recruitment (1). However, data from randomised studies with radiotherapy and concurrent radiosensitisers (chemotherapy and carbogen and nicotinamide) suggest equivalent outcomes and survival to historical surgical series (2,3). NICE recommends offering patients a choice between treatment modalities, and in this context, Quality of life (QOL) is important for patients and clinicians. Prospective studies comparing outcomes between surgery and radiotherapy are limited, one published prospective study has used non validated assessment tools and with only 3 months follow up post treatment (4). The Q-ABC study is a non-randomised UK study collecting prospective patient reported outcomes following radical treatment.

Material/Methods:

Eligible participants had MIBC, undergoing curative treatment with either surgery or radiotherapy, with or without neo-adjuvant chemotherapy, and completed a baseline assessment of all domains, prior to commencing treatment. In participants treated with neo-adjuvant chemotherapy, a second baseline assessment was carried out after chemotherapy. Participants were followed up for 2 years after definitive treatment and completed assessments 6 monthly. The primary outcome is assessed using the Functional Assessment of Cancer Treatment – Bladder (FACT-Bl), which measures five domains in bladder cancer patients (physical, social, emotional, functional well-being) and a bladder cancer subscale. Secondary outcomes include: baseline demographics; disease and symptom characteristics; Assessment of Fear of Recurrence (FOR) using the Kornblith scale before and after treatment; documenting overall survival and distant recurrence rates; assessment of treatment related morbidity, comparing clinician graded toxicity and patient reported outcomes at one year; and a cost effective analysis using the health economic questionnaire EQ-5D-5L and UK cancer costs questionnaire. The study was conducted across 35 sites in the UK. Recruitment commenced in March 2018 and completed October 2022. 365 participants were recruited, however, following exclusions due to ineligible patients and incomplete baseline datasets, 330 were available for analysis. The mean age in the surgical cohort was 69.6 years, versus 74 in the radiotherapy group. Consistent with epidemiological data more than 70% of participants were male and a suggestion that proportionally more women underwent radical surgery (29% vs 18.7%). There was higher comorbidity, according to the Charleston Comorbidity Index in the radiotherapy group ( Median 1 vs 0), and also participants had poorer performance status(PS) , 60% PS 0 versus 84% in the surgical group. There was no significant difference in staging across the two groups. Baseline FACT-Bl scores were largely similar between the groups for all 5 domains and median total scores, surgery 121.2 and radiotherapy 120.6. With regards to the EQ-5D- 5L an higher proportion reported “no problems”, with regards to self-care, mobility and ability to carry usual activities in the surgical group, reflecting the fitter and Results: