Chemo - radiation best for bladder cancer, study finds

By Maureen Salamon, HealthDay Reporter
Chemo + radiation best for bladder cancer, study finds
Adding fluorouracil, mitomycin C led to significantly better survival rates.

(HealthDay) -- 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 ," 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 .

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 , five-year survival rates are about 45 percent regardless of treatment.

For younger, healthier patients, bladder removal -- known as radical cystectomy -- is considered the gold standard of care for . 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 , fluorouracil and mitomycin C. In addition to improved , the number of patients needing bladder removal as a "salvage therapy" -- because other treatments failed -- was lower among those receiving 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 costs.

"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."

More information: The U.S. National Library of Medicine has more about bladder cancer.

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