Bladder Cancer Survival Better with Chemo

Invasive bladder cancer survival odds improved with chemotherapy before or after surgery

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Patients with deadly bladder cancer usually have surgery. There is additional treatment to improve their survival odds, but it may not be used as often as it should be, new research has shown.

A new study has found that although chemotherapy given before surgery for high-risk bladder cancer improved the odds of survival five years after diagnosis, few patients received this treatment.

The research also found that chemotherapy given after surgery also may increase chances that these high-risk patients will survive longer than if they have surgery alone.

"If you're having surgery for bladder cancer, ask your doctor about chemotherapy."

This new study was led by Christopher Booth, MD, of Queen’s University Cancer Research Institute in Ontario, Canada.

Dr. Booth and colleagues found that patients who received chemotherapy in the 16 weeks before surgery for high-risk bladder cancer, or in the 16 weeks after surgery, had about a 28 percent higher chance of living five years than if they did not have chemotherapy.

High-risk bladder cancer is muscle-invasive cancer. Many patients ultimately die of distant metastases (cancer spread) even if the initial cancer is controlled. Treatment guidelines in Canada have recommended giving these patients chemotherapy prior to operating, the study authors noted.

These authors conducted a study to find out how often this advice was followed.

They identified patients with bladder cancer using the Ontario Cancer Registry. From 1994 to 2008, 2,944 patients had surgery for high-risk cancer in Ontario. The researchers obtained surgical pathology reports confirming the diagnoses.

These researchers found that throughout the study period, the use of chemotherapy prior to surgery stayed stable — about 4 percent of patients received the treatment.

Surprisingly, although it wasn’t recommended, the use of chemotherapy after surgery increased through the years, from about 16 percent of patients from 1994 to 1998 to 22 percent of patients from 2004 to 2008.

The use of chemotherapy was notably lower among older patients and higher among patients with a poor prognosis (predicted outcome).

Chemotherapy at either point in time (within four months before or after surgery) increased odds the patient would live for five years by about 28 percent, the researchers reported. Chemotherapy given after surgery led to slightly better odds than chemotherapy given before, they found.

“Given the potential for perioperative chemotherapy [chemotherapy given around the time of surgery] to improve patient outcomes, further efforts are needed to understand reasons for underutilization,” the authors wrote.

"Other research groups in the US and Europe have also identified low utilization rates for peri-operative chemotherapy in bladder cancer," Dr. Booth told dailyRx News.

"In that sense our results were not a major surprise. However, what did surprise us what the fact that utilization rates of chemotherapy before surgery did not change in any major way in Ontario between 1994 and 2008 despite the publication of numerous clinical trials and provincial treatment guidelines," he said.

"This was a retrospective study that looked at how commonly chemotherapy was used on patients with advanced bladder cancer before and after cystectomy. Survival rates were also examined,” noted S. Adam Ramin, MD, an expert in prostate cancer and robotic laparoscopic prostatectomy who is on staff at a number of prestigious medical centers, including City of Hope National Medical Center and Cedars Sinai Medical Center. “The study found that in patients who did not receive chemotherapy before surgery, use of chemotherapy after still did improve survival, as compared to using no chemotherapy. “

Dr. Ramin added, “Some of the weaknesses of this study included lack of randomization, over-preponderance [too many] of patients with very advanced disease, and being a retrospective article. In the future, prospective, randomized trials with specific inclusion and exclusion criteria looking at post-surgical chemotherapy will be needed."

This study was published in the journal Cancer.

No disclosures were made.

Review Date: 
April 11, 2014
Last Updated:
April 14, 2014