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Although chemotherapy and radical cystectomy are traditionally used to treat muscle-invasive disease, a recent analysis shows similar overall survival outcomes in patients treated with chemoradiotherapy.
Effective treatment for patients with muscle-invasive bladder cancer may not require the removal of their bladder, according to findings published in Cancer Medicine.
Researchers from Beaumont Health in Michigan compared patients who received limited surgery followed by combination chemotherapy and radiation with those who underwent chemotherapy followed by radical cystectomy (removal of the bladder) — the traditional treatment for this type of disease, which has a high-risk of spreading.
They examined 7,322 patients with stage 2 to stage 4 muscle-invasive bladder cancer using the National Cancer Database. The chemotherapy/cystectomy regimen was used in 5,664 patients, while 1,658 received chemoradiotherapy. All patients were treated between 2004 and 2014.
Patients in the chemotherapy/cystectomy group were younger on average by 11.5 years, had fewer comorbidities and had been treated at academic facilities. In addition, more of these patients had private insurance. Researchers reported no significant differences in race or income among both groups.
Upon controlling factors of age, baseline health/performance status and clinical disease stage, researchers determined similar overall survival outcomes whether patients received chemotherapy/cystectomy or chemoradiotherapy to treat their cancer. “This is a big deal. No one wants their bladder removed,” Craig Stevens, M.D., Ph.D., chairman of radiation oncology at Beaumont Health, said in a press release.
Moreover, bladder removal could cost patients quality of life. “Unfortunately, radical cystectomy is associated with significant perioperative morbidity and mortality with 67 percent of patients experiencing complications and up to 2 percent death rate within 90 days of surgery,” the researchers wrote.
These findings could potentially spare patients from experiencing these concerns. “Our analysis contributes further support to the use of organ preservation through a combination chemotherapy/radiotherapy as a viable option in the management of muscle-invasive bladder cancer,” lead researcher Hong‐Yiou Lin, M.D., Ph.D., from the Department of Radiation Oncology at Beaumont Health, said in the release.
Bladder cancer is one of the most common cancers diagnosed in the United States with more than 80,000 cases estimated to be diagnosed this year, according to the American Cancer Society. The disease will mainly affect men.
About half of all bladder cancers are found while the cancer is still confined to the inner layer of the bladder wall, which is called non-invasive bladder cancer. The disease is called muscle-invasive bladder cancer when it spreads into the muscle wall of the bladder. This accounts for about 25 percent of all cases.
“In the case of bladder cancer, we have good data to support organ-sparing therapy,” Daniel Krauss, M.D., radiation oncologist at Beaumont Hospital, said in the release. “There is no reason for doctors not to try this therapy first, and it’s been shown previously that if it doesn’t work, the bladder can be removed at that point without a significant increase in the surgical complication rate.”