Objective: To gain insight into variations in treatment policy for patients with non-metastatic muscle-invasive bladder carcinoma.
Design: Retrospective observational cohort study.
Method: A total of 232 patients with non-metastatic muscle-invasive bladder carcinoma in the region of the Comprehensive Cancer Centre the Netherlands, location Leiden in the Netherlands in the period 2003-2005, were examined to ascertain whether treatment guidelines had been adhered to and which factors contributed to variations in policy. Overall and progression-free survival was compared between curative-intent treatment with cystectomy and with radiotherapy.
Results: In total 91% of the patients younger than 75 years were treated with curative intent. In patients of 75 years and over, this proportion varied between 77% of those without comorbid disease to 37% of those with more than 1 comorbid conditions. Only 40% of all patients underwent cystectomy as standard treatment. Age was the most important motivation in deciding against surgery. The proportion of patients who underwent cystectomy in the hospitals studied varied between 17% and 54%. In one hospital, this proportion was significantly lower than the regional average. Neoadjuvant chemotherapy was used in only a few hospitals in selected patients. There was no demonstrable difference in overall and progression-free survival between patients who underwent cystectomy and those treated with curative-intent radiotherapy.
Conclusion: Age was the deciding factor in the choice of treatment for patients with muscle-invasive bladder carcinoma. The percentage treated by cystectomy varied between hospitals. We recommend thorough documentation of the considerations taken into account when deviating from guidelines.