Bladder cancer recurrence lowered by combination therapies


Trials in Birmingham have revealed that by combining chemo and radiation treatments, recurrence of bladder cancer can be reduced.


In the studies, patients suffering with muscle-invasive bladder cancer were given the chemotherapy treatments fluorouracil and mitomycin C, together with radiotherapy.

Combining the 2 methods led to a significant reduction in bladder cancer recurrence compared with patients who had received only radiotherapy, according to Prof Nicholas James of the University of Birmingham. The combined treatment also showed no significant increase in adverse events.

Recording the study's findings in the US New England Journal of Medicine, Prof James wrote: "It may be time to re-evaluate the relative roles of bladder preservation and surgery in the treatment of muscle-invasive bladder cancer, particularly for patients at high risk for complications from surgery."

Dr William Shipley and Dr Anthony Zietman, both of Massachusetts General Hospital, wrote in an accompanying editorial that the Birmingham study is "potentially practice-changing for patients with muscle-invasive bladder cancer."

For people with bladder cancer, radiotherapy has long been an alternative to cystectomy. The research team observed that with some other diseases, combining chemo with radiotherapy improves local control and survival compared with radiotherapy alone.

The researchers tested the effects of the available bladder cancer treatments on 360 patients from 45 centres across the UK, randomising them to either just radiotherapy or combination chemo-radiotherapy.

The New England Journal of Medicine noted that the Birmingham findings were similar to those seen when the combination method was used on anal cancer, for which chemo-radiotherapy is now the standard treatment.

"Cystectomy will always remain part of an organ-sparing approach," the editors wrote, "but this trial shows that as primary treatment, it can now be regarded as one of several options for the patient."

The findings of Dr James's team were welcomed by the New Jersey physician Dr Manish Vira, who wrote that the results "establish that the addition of chemotherapy to radiotherapy should become standard practice for organ-preserving treatments of bladder cancer."

However, Dr Vira cautioned that more data is needed in the long term to "establish that chemoradiotherapy can achieve the oncologic efficacy of radical cystectomy at 5 and 10 years."

Emma Costin, Industrial Illness Solicitor at Simpson Millar LLP said: "Bladder Cancer has long been associated with many industrial areas of work and can be the result of exposure to hazardous substances within the workplace. Any trials that can help treat victims of bladder cancer or reduce the risk of recurrence have to be commended."

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