Study Shows Benefits of Adding Chemotherapy to Radiation Therapy
By Charlene Laino
WebMD Health News
Reviewed by Laura J. Martin, MD
Nov. 2, 2010 (San Diego) -- The addition of chemotherapy to radiation for the treatment of bladder cancer allowed more people to remain disease free than if they received radiation alone, British researchers report.
"By adding chemotherapy to radiation therapy, 82% of [living] patients were free of invasive bladder cancer -- the most worrisome form of the disease -- two years after treatment," Nicholas James, MD, professor of clinical oncology at the University of Birmingham, England, tells WebMD.
"This compared to 68% of those who received radiation alone."
That corresponds to cutting the risk of an invasive recurrence by nearly half, James says.
"In the majority of cases, people were able to preserve normal urinary function," he says. "For patients, that's hugely important."
The findings come a day after former basketball star Maurice Lucas died from bladder cancer.
Invasive Bladder Cancer
A recurrence of invasive bladder cancer occurs in the muscle of the bladder wall, James says. "It's what kills you."
In contrast, a recurrence of superficial bladder cancer occurs in the lining of the bladder. "The surgeon can just scoop it out. It's not life-threatening," James says.
In the study, treatment with chemotherapy and radiation allowed 67% of patients who were still alive to be free of all disease in their bladders -- including superficial cancer -- two years after treatment, compared with 54% of people who received radiation alone.
The study involved 360 people with invasive bladder cancer. About half got radiation alone and half got chemo plus radiation.
James says that the study involved older people than in most studies. Their average age was about 73, and 15% were over 80.
The study, which James says is the largest of its kind, was presented here at the 52nd annual meeting of the American Society for Radiation Oncology (ASTRO).
Side Effects of Treatment
During treatment, there was an increase in serious side effects such as an extreme drop in the number of infection-fighting white blood cells in the group receiving chemotherapy: 36% vs. 28% in the group getting radiation alone, James says. But the difference was so small, it could have been due to chance, he says.
Nearly all patients in both groups -- 80% to 90% of those who got radiation alone and 85% to 95% of those who also got chemo -- reported some side effects such as nausea or fatigue.
After treatment, the rate of side effects was the same in both groups. "Seventy percent of patients reported no side effects at all after three months," he says.
By two years after treatment, about 60% of people in both groups were still alive. If the study was larger, "we might see a difference in survival rates. This study was not powered to show a difference," says Phillip Devlin, MD, a radiation oncologist at Harvard Medical School who was not involved with the study.
Bladder Cancer in Men
Bladder cancer affects about 70,000 Americans each year, according to ASTRO. It is four times more common in men than in women and two times more common in whites than African-Americans. Cure rates for advanced invasive bladder cancer are generally poor, with less than 40% of patients living more than five years after diagnosis.
In the U.S., the most common treatment for invasive bladder cancer is complete removal of the bladder, which means the patient has to wear a bag to collect urine for life, James says.
"We've shown that the addition of a small amount of chemotherapy to radiation gives you very good control of the bladder even in the very elderly, 80-plus patient who often can't tolerate surgery. This may shift the balance from surgery to chemoradiation as the primary treatment for many patients with invasive bladder cancer," James says.
Devlin tells WebMD that in the U.S., patients who are not fit for surgery or don't want it are increasingly being offered a combination of chemo and radiation.
"This is a well-designed study confirming a trend across oncology showing combination therapies are often better than single therapies," he says.
This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
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SOURCES: 52nd Annual Meeting of the American Society for Radiation Oncology, San Diego, Oct. 31- Nov. 4, 2010.Nicholas James, MD, professor of clinical oncology, University of Birmingham, England.Phillip Devlin, MD, chief, brachytherapy, Harvard Medical School, Boston.
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