Radiation vs. Surgery for Bladder Cancer

Bladder cancer radiation delivered less toxic tumor control than surgery

(RxWiki News) Even though surgery is commonly used to remove solid tumors, some patients are unable or unwilling to undergo the operation. In such cases, doctors rely on other forms of treatment such as chemotherapy and radiation.

Recently published research found that radiation therapy controlled invasive bladder cancer about as well as surgery.

"Thoroughly discuss cancer treatment options."

Robert A. Huddart, PhD, of The Institute of Cancer Research in London and The Royal Marsden NHS Foundation Trust, and colleagues conducted this study to evaluate radiotherapy effectiveness in invasive bladder cancer tumor control and late toxicity effects (side effects that appear one or two years after treatment).

When cancer spreads to the bladder muscles, the disease is called muscle-invasive bladder cancer. The standard treatment for this type of bladder cancer is the removal of all or part of the bladder with a surgery called a cystectomy.

Some bladder cancer patients are physically unable to undergo a cystectomy, and others are unwilling to lose this organ that holds urine.

There have been concerns that, as an alternative to surgery, radiation therapy is inadequate in preventing the cancer from returning and that the radiation itself can result in late toxic effects.

In light of these concerns, Dr. Huddart and colleagues looked at the effect of two different radiation protocols.

In this phase lll trial, 219 patients were assigned to receive either the standard therapy of 55 units of radiation given in 20 sessions over four weeks or reduced high-dose volume of 64 units of radiation given in 32 sessions over 6.5 weeks.

The reduced high-dose regimen delivered full radiation to the tumor and then 80 percent of the maximum dose to the rest of the bladder.

Over a median follow-up period of 72.7 months after treatment, the patients were regularly assessed for toxicity and side effects and to make sure the cancer had not returned.

Serious toxicities were reported by 13 percent of patients in both groups at two years. There were no significant differences in the toxicity rate between the two groups.

At two years, 61 percent of the patients who received the standard radiation protocol had not seen the cancer return, nor had 64 percent of the patients in the reduced high-volume group.

The authors of this study concluded that radiation treatment may be an effective alternative to surgery for muscle-invasive bladder cancer patients.

Alexis Harvey, MD, medical director of the NJ Region of 21st Century Oncology, told dailyRx News, "Organ preservation has had increasing significance in the treatment of many types of cancer. These studies confirm that with precise delivery of radiation to the bladder, dose escalation can be utilized to target the tumor only, sparing normal tissue, without a significant difference in side effects.

"In the future this could lead to less radical surgical intervention being needed," said Dr. Harvey, who was not involved in this study.

Findings from this study were published October 1 in the International Journal of Radiation Oncology Biology Physics, the official scientific journal of the American Society for Radiation Oncology (ASTRO).

The trial was sponsored by the University of Birmingham, UK, supported by Cancer Research UK and facilitated by the National Institute for Health Research Cancer Research Network.

No conflicts of interest were disclosed.

Review Date: 
October 15, 2013