Radiation, Chemo Beats Bladder Surgery

Bladder cancer treatment with combination therapy

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Bladder cancer is normally been treated with surgery alone, but the risk of complications from any surgery prevent it from being the solution for everyone.

A study published on the use of chemotherapy and radiation in bladder cancers that have progressed too far for surgery suggests that despite the traditional preference, surgery isn't the best treatment for bladder cancer.

"Ask your oncologist about combination therapy."

Taking their lead from several other studies, a group of researchers from the United Kingdom tested combination therapy as a solution for bladder cancer patients ineligible for surgery.

In the end, radiation and chemotherapy may be just as effective as surgery for bladder cancer, they concluded.

The five year survival rate was 48 percent for combination therapy, and 35 percent in the radiation only group. Long term results from using the combination therapy were equivalent to those of the very best surgeons.

Fluorouracil and mitomycin C were used for chemotherapy, in conjunction with radiation. Five year survival for cytectomy, or surgical removal of the bladder, is generally around 45 percent.

Success came at a cost, with combination therapy patients having more serious side effects, mostly toxic effects on the gastrointestinal system including moderate bleeding, nausea, vomiting and diarrhea.

The study used data from 579 patients, with many randomly selected to undergo chemotherapy with radiation, or treatment with radiation alone.

Using combination therapy instead of surgery has the added value of keeping the bladder, and removal of the bladder opens up a large number of problems for patients further down the road.

Although researchers admitted that the topic was worthy of further study, their results place combination therapy on equal footing with surgery, and recommend it be considered for difficult or advanced cases of bladder cancer.

"It may be time to re-evaluate the relative roles of bladder preservation and surgery in the treatment of muscle-invasive bladder cancer, particularly for patients at high risk for complications from surgery," the study authors concluded.

The research was published online in the New England Journal of Medicine, with an accompanying editorial, on April 19th.

This study was supported by Cancer Research UK and the National Institute for Health Research. No other financial disclosures were made by the research team.

Reviewed by: 
Review Date: 
April 26, 2012
Last Updated:
October 24, 2012