Chemo plus radiotherapy reduces risk of bladder cancer recurrence

Bladder cancer patients receiving low doses of chemotherapy combined with radiotherapy were nearly 50% less likely to relapse with muscle-invasive disease compared with patients given radiotherapy alone, a recent study found.

The study, which was published in the New England Journal of Medicine (2012; 366:1477-88), included 360 patients from around the United Kingdom. Around half were given fluorouracil and mitomycin C (Mutamycin) in addition to the radiotherapy treatment. Thirty-three percent of patients receiving chemotherapy in addition to radiotherapy had a relapse within their bladder or surrounding tissues within 2 years, compared with 46% of those who had radiotherapy alone.

Among those that did relapse in the chemoradiotherapy group, approximately 20% had muscle-invasive cancer compared with approximately 33% among those given radiotherapy alone.

Early results also showed that combining radiotherapy with chemotherapy may improve survival, with 48% of patients still alive after 5 years compared with 35% of those who had radiotherapy alone, although larger studies are needed to confirm this.

"We found that adding chemotherapy to radiotherapy successfully lowered the risk of relapse sufficiently to make it a real option for patients who don’t wish to have radical surgery and lose their bladder," said senior author Robert Huddart, MD, of The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London. "Importantly, these improvements have been achieved with drugs that are cheap and widely available, and carry few additional side effects over radiotherapy alone."

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