WEDNESDAY, April 18 (HealthDay News) -- The addition of two
well-tolerated chemotherapy drugs to radiation therapy led to
significantly longer survival rates among patients with
muscle-invasive bladder cancer.
In a new study splitting 360 patients into groups receiving
radiation alone or radiation plus chemotherapy, British researchers
found that those undergoing combined therapies had a 67 percent
rate of local disease-free survival after two years, compared with
54 percent in the radiation group. Five-year overall survival rates
were 48 percent in the chemo-radiation group, compared with 35
percent in the radiation-only group.
"Overall, the results establish that the addition of chemotherapy to radiotherapy should become standard practice for organ-preserving treatments of bladder cancer," said Dr. Manish Vira, director of the fellowship program in urologic oncology at the Arthur Smith Institute for Urology in Lake Success, N.Y. "The tried-and-true treatment method is still [bladder removal] and certainly we are moving toward a more multi-disciplinary approach."
The study is published April 19 in the
New England Journal of Medicine.
About 385,000 cases of bladder cancer are diagnosed annually
worldwide, according to study authors, with the average age at
diagnosis over 70. For those whose cancer has invaded the bladder
muscle, five-year survival rates are about 45 percent regardless of
For younger, healthier patients, bladder removal -- known as
radical cystectomy -- is considered the gold standard of care for
invasive bladder cancer. But older patients with co-existing
medical conditions may not be as well-equipped to tolerate
complications of the procedure, experts said.
The new study, the largest late-stage trial of its kind, was
conducted at 45 medical facilities in the United Kingdom. Patients
were randomly assigned to undergo daily radiation alone or
radiation along with two chemotherapy drugs, fluorouracil and
mitomycin C. In addition to improved survival rates, the number of
patients needing bladder removal as a "salvage therapy" -- because
other treatments failed -- was lower among those receiving
radiation plus chemotherapy.
Adverse effects from the chemotherapy -- including diarrhea,
sore mouth or suppression of blood cell production -- were low
among participants and were managed by lowering drug dosages, said
study author Dr. Nicholas James, a professor of clinical oncology
at the University of Birmingham. in England.
Cost of the chemotherapy drugs is relatively inexpensive, he
said -- about $1,600, plus pharmacy and intravenous administration
"We were pleasantly surprised by the overall results, particularly the low reported toxicity in the chemo-radiotherapy arm compared to the radiotherapy-only group," James said. "We feel the results are sufficient to change practice . . . the drugs are cheap and safety was good in an elderly population."
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