Chemotherapy plus radiation reduces the risk of recurrence in muscle-invasive bladder cancer patients by nearly 50% compared to radiation alone, according to the results of a study published in the New England Journal of Medicine.
Bladder cancer is diagnosed in roughly 50,000 men and 17,000 women annually in the United States. Patients with T2-T4a bladder cancer have cancer that is considered non-metastatic but that has invaded the muscle wall. Recent research has indicated that optimal treatment of these cancers includes the combination of several different modalities.
This randomized phase III study included 360 patients with T2-T4a bladder cancer from 45 cancer centers in the United Kingdom. Patients were randomized to receive radiation alone or chemotherapy plus radiation. Chemotherapy treatment consisted of fluorouracil and mitomycin C.
The results indicated that loco-regional disease-free survival was significantly better in the group receiving chemotherapy plus radiation than the group receiving chemotherapy alone. The 2-year recurrence-free rate was 67% in the chemotherapy/radiation group, compared to 54% in the radiation group.
Furthermore, patients who received chemotherapy in addition to radiation were nearly 50% less likely to develop invasive cancer compared to their counterparts.
After 5 years, 48% of patients in the chemotherapy/radiation group were alive, compared to 35% in the radiation group. Grade 3 or 4 adverse events were slightly more common in the chemotherapy plus radiation group, but the difference was not significant.
After a median follow-up of 69.9 months, researchers concluded that the addition of chemotherapy to standard-dose radiation was associated with a relative reduction of 33% in the risk of loco-regional recurrence with a reduction of almost 50% in invasive recurrence.
 James ND, Hussain SA, Hall E, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. NEJM. 2012; 366:1477-1488.
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