Adding chemotherapy to radiotherapy halves risk of bladder cancer returning

Bladder cancer patients given low doses of chemotherapy combined with radiotherapy were nearly 50 per cent less likely to relapse with the most lethal form of the disease compared to patients given radiotherapy alone.

The success of the trial – led by The Institute of Cancer Research (ICR) and the University of Birmingham – could mean fewer patients need their bladder removed and provides a viable alternative for frailer patients who are too weak for surgery.

Three hundred and sixty patients from around the UK were included in the study. Around half were given two commonly used chemotherapy drugs – fluorouracil and mitomycin C – in addition to the radiotherapy treatment.
Around one third of patients receiving chemotherapy in addition to radiotherapy (known as chemoradiotherapy) had a relapse within their bladder or surrounding tissues within two years, compared to 46 per cent of those who had radiotherapy alone.

Of those who received chemoradiotherapy, around one in five developed invasive cancer – the most serious form of the disease – compared to around one in three among those who had radiotherapy alone.

Early results also showed that combining radiotherapy with chemotherapy may improve survival, with 48 per cent of patients still alive after five years, compared to 35 per cent of those who had radiotherapy alone, although larger studies are needed to confirm this.

Removing the bladder is still one of the most effective treatments for invasive cancer that has spread into the muscle of the bladder. But many patients are too frail for such radical surgery, while others may want to avoid a major operation with implications for the rest of the patient’s life.

The trial was co-led by Dr Robert Huddart from the ICR and The Royal Marsden, and jointly co-ordinated by the ICR’s Clinical Trials and Statistics Unit.

The study was published in the New England Journal of Medicine