Chemotherapy plus radiation prevents bladder cancer recurrences

Adding chemotherapy to radiation therapy for muscle invasive bladder cancer allows 67 percent of people to be free of disease in their bladders two years after treatment.

This compares to 54 percent of people who receive radiation alone, according to the largest randomized study of its kind presented at the plenary session, November 1, 2010, at the 52nd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

“The trial shows that this treatment offers improved control of cancer within the bladder with acceptable long-term side effects and is therefore a viable alternative to radical surgery in patients with muscle invasive bladder cancer,” said Nicholas James, M.D., an oncologist at University of Birmingham in Birmingham, England, United Kingdom, who jointly led the study with Robert Huddart, M.D., from the Institute of Cancer Research in the United Kingdom. “This may shift the balance from surgery to chemo-radiotherapy as the primary treatment for many patients with invasive bladder cancer.”

Bladder cancer affects about 70,000 Americans each year. It is four times more common in men than in women and two times more common in Caucasians than African-Americans. Cure rates for advanced bladder cancer are generally poor, with only around 40 percent of those with this form of the disease living more than five years after diagnosis.

In the United States, the most common treatment for advanced bladder cancer is complete removal of the bladder, which compromises patients' normal urinary function. Radiotherapy has been used as an alternative for some time. Doctors have been making advances in combining radiation therapy and chemotherapy as a way to treat bladder cancer while allowing patients an opportunity to maintain normal bladder function.

This multicenter randomized trial, conducted at 45 institutions in the United Kingdom, examined whether adding chemotherapy to radiation treatment is safe and more effective than giving radiation alone in preventing bladder cancer from returning. The trial also compared two ways of giving radiation therapy.

From August 2001 to April 2008, 458 invasive bladder cancer patients entered the trial. Results of the study show that the combination of chemotherapy and radiation treatment reduced the long-term risk of recurrence of cancer within the bladder, while also preserving bladder function.

This work was supported by Cancer Research U.K. (CRUK/01/004). The trial was coordinated by the Cancer Research U.K. Clinical Trials Unit at the University of Birmingham and the Cancer Research U.K. funded Clinical Trials and Statistics Unit at the Institute of Cancer Research (ICR-CTSU) with statistical support led by Emma Hall, Ph.D., deputy director (Research), ICR.

For more information on radiation therapy for bladder cancer, visit www.rtanswers.org/treatmentinformation/cancertypes/bladder.

The abstract, “Results of a 2×2 Phase III Randomized Trial of Synchronous Chemo-radiotherapy (CRT) Compared to Radiotherapy (RT) Alone and Standard Versus Reduced High Volume RT in Muscle Invasive Bladder Cancer (MIBC) (BC2001 CRUK/01/004)” will be presented at the plenary session at 2:30 p.m. on Monday, November 1, 2010. To speak to the lead author of the study, Nicholas James, M.D., please call Beth Bukata or Nicole Napoli on October 31 – November 2, 2010, in the ASTRO Press Room at the San Diego Convention Center at 619-525-6313 or 619-525-6314. You may also e-mail them at bethb@astro.org or nicolen@astro.org