Patients with muscle-invasive bladder cancer may be better treated with chemoradiotherapy than radiotherapy alone, results published in the New England Journal of Medicine suggest.
Lead author Nicholas James (Professor of Clinical Oncology at the University of Birmingham) and colleagues randomly assigned 360 patients with muscle-invasive bladder cancer to receive chemoradiotherapy or radiotherapy alone to investigate their effect on relapse, overall survival and toxicity.
At two years, patients assigned to chemoradiotherapy were less likely to have experienced recurrence, at 33%, than those given radiotherapy alone, at 46%.
Patients assigned to chemoradiotherapy received 500mg per square metre of body surface area per day on days one to five and 16 to 20, plus a 12mg per square metre of mitomycin C on day 1.
Chemoradiotherapy recipients were also more likely to reach five-year survival than those assigned to radiotherapy alone, at 48% versus 35%.
Professor James told the website of Aunt Minnie that he believed physicians should respond to the findings by reconsidering the use of cystectomy, which he says is widely considered the standard of care for muscle-invasive bladder cancer.
Further to this, many physicians believe that radiotherapy can shrink patients’ bladders and leave them with reduced function. However, the trial results contradicted this belief with the finding that a small, 10% reduction in bladder size followed radiotherapy.
The team conclude: “Synchronous chemotherapy with fluorouracil and mitomycin C combined with radiotherapy significantly improved locoregional control of bladder cancer, as compared with radiotherapy alone, with no significant increase in adverse events.”