A new standard of care in muscle-invasive bladder Ca?

March 14, 2017

Chemoradiotherapy is an effective alternative to cystectomy in the primary management of muscle-invasive bladder cancer, British researchers say.

With a median follow-up of almost a decade, patients with muscle-invasive bladder cancer who had chemoradiotherapy had improved locoregional control and a reduced salvage cystectomy rate compared to those who had radiotherapy alone, according to research presented at the Genitourinary Cancers Symposium, Orlando, FL.

Chemoradiotherapy, with fluorouracil (5FU) and mitomycin, should be a standard of care for these patients, the study authors say.

Also see: A new standard of care in muscle-invasive bladder Ca?

The take-home message to urologists from the Cancer Research UK-funded phase III trial, according to co-lead author Professor Emma Hall, PhD, of the Institute of Cancer Research, London, is that chemoradiotherapy is an effective alternative to cystectomy in the primary management of muscle-invasive bladder cancer.

“Patients preserve their bladder and have good long-term quality of life outcomes,” she said.

Dr. Hall and colleagues studied 458 patients with muscle-invasive bladder cancer who received radiotherapy or chemoradiotherapy, and, for the radiotherapy comparison, standard radiotherapy versus reduced high-dose volume radiotherapy.

Next: 2-year salvage cystectomy rate 11% in the chemoradiotherapy group, compared to 17% among those on radiotherapy only

 

With a median follow-up of 118 months, they found locoregional control and invasive locoregional control were better in the chemoradiotherapy group, but overall survival was not statistically different between groups. There were, however, trends toward improvement in bladder cancer-specific survival and metastasis-free survival among those receiving the radiotherapy-chemotherapy combination. The 2-year salvage cystectomy rate was 11% in the chemoradiotherapy group, compared to 17% among those on radiotherapy only.

The finding of no significant improvement in overall survival in this elderly population might be due in part to effective salvage treatment at recurrence, as evidenced by the increased cystectomy rate with radiotherapy alone, according to Dr. Hall.

“The radiotherapy volume modification used did not reduce toxicity, but there is no evidence of an increase in local failure rate, suggesting it is safe to pursue clinical trials of volume-sparing radiotherapy using newer technology [and] adaptive delivery techniques,” she said.

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As for whether there are potential drawbacks of adding chemotherapy to these patients’ treatment, Dr. Hall says patients may experience some short-term side effects associated with chemotherapy.

“But, in our study, there was no statistically significant differences between chemoradiotherapy and radiotherapy alone in acute grade 3 or 4 toxicity nor in late toxicity,” she said.

Urologists, according to Dr. Hall, should consider bladder preservation treatment options.

Dr. Hall has received institutional research funding from Accuray, AstraZeneca, Aventis Pharma, and Bayer. Her co-authors have a financial or other relationship with several pharmaceutical companies.

More on Bladder Cancer:

Immunotherapy approved for advanced urothelial Ca

Bladder cancer surveillance: Challenges and opportunities

Bladder Ca linked to risk of second primary cancer

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