Shorter radiation regimen lowers risk of bladder cancer recurrence

A hypofractionated radiotherapy course was linked to a lower risk of recurrence versus a longer course in patients with bladder cancer, according to a meta-analysis of 2 randomized phase 3 trials.^1,2

The results, which were published in the Lancet Oncology, showed that at a median follow-up of 120 months, the hypofractionated schedule was associated with a 29% (HR, 0.71) lower risk of invasive locoregional recurrence compared with a longer radiotherapy regimen. The risk reduction was observed regardless of whether the patients were treated with chemotherapy plus radiotherapy, or radiotherapy alone.

The analysis also showed that invasive locoregional control at 3 years was noninferior with hypofractionated radiotherapy, and the toxicity profile was similar between the 2 treatment courses.

“This study presented a unique opportunity to use data from 2 large randomized clinical trials to make comparisons between the 2 different radiotherapy schedules used to treat muscle invasive bladder cancer in the UK. Using robust statistical methods, we showed that the shorter course of radiotherapy was at least as good for patients overall and reduced the likelihood of a person’s cancer coming back after treatment,” study co-leader Nuria Porta, PhD, principal statistician at The Institute of Cancer Research, London, stated in a press release.

“Not only is the shorter course more convenient for patients, but it also helps keep people out of hospital for their own good and to free up NHS resources, which is a vital consideration during the current pandemic,” added Porta.

The analysis included data from 782 patients with locally advanced bladder cancer enrolled in either the phase 3 BC2001 trial (456 patients) or the phase 3 BCON trial (326 patients). Among these patients, 376 received 64 Gy in 32 fractions over 6.5 weeks and 406 received the hypofractionated schedule of 55 Gy in 20 fractions over 4 weeks.

"Our study shows that people with bladder cancer can receive the same or even better results in a shorter course of radiotherapy that is delivered over four weeks, versus the longer course over six and a half weeks. Shorter radiotherapy courses involving lower overall radiation dose have already been proven to be just as effective at treating other cancer types, including breast cancer and prostate cancer, than longer, higher-dose options. The new findings are an important step forward in bringing kinder, smarter treatment to patients with bladder cancer and are especially timely in the current Covid-19 era, where there is a real imperative to keep patients out of hospital wherever possible,” joint study leader Robert Huddart, PhD, professor of Urological Cancer at The Institute of Cancer Research, London, and consultant in Urological Oncology at The Royal Marsden NHS Foundation Trust, stated in the press release.

“We are strongly advocating the widespread use of the shorter course of radiotherapy for bladder cancer and believe it should be adopted as the new standard of care for patients with the disease,” added Huddart.

References

1. Shorter radiotherapy course reduces risk of bladder cancer returning. Published online February 2, 2021. Accessed February 2, 2021. https://bit.ly/39FBDCF.

2. Choudhury A, Porta N, Hall E, et al. Hypofractionated radiotherapy in locally advanced bladder cancer: an individual patient data meta-analysis of the BC2001 and BCON trials. Lancet Oncol. 2021;22(2):246-255. doi: 10.1016/S1470-2045(20)30607-0