Chemoradiotherapy decreases recurrence risk in muscle-invasive bladder cancer.
Major finding: Chemoradiotherapy decreases recurrence risk in muscle-invasive bladder cancer.
Approach: A randomized, phase III trial compared chemoradiotherapy with radiotherapy alone.
Impact: Patients with muscle-invasive bladder cancer may be able to avoid cystectomy.
The standard therapy for muscle-invasive bladder cancer is cystectomy, or the removal of all or part of the bladder. However, this type of cancer often affects older patients who may not be candidates for a radical surgical intervention. Although radiotherapy has been investigated as a treatment alternative, its use worldwide varies substantially. The prognosis remains poor, and recurrence rates are high, ultimately leading to salvage cystectomy in around a third of cases. In an effort to improve bladder-preserving treatments for muscle-invasive bladder cancer, James and colleagues performed a randomized, phase III trial comparing synchronous chemoradiotherapy with fluorouracil and mitomycin C with radiotherapy alone in 360 patients. The authors found that synchronous chemotherapy combined with radiotherapy improved the risk of both locoregional and invasive recurrence of bladder cancer in addition to overall survival. Compared with the radiotherapy group, patients who received chemoradiotherapy had an increase in the 2-year recurrence-free rate from 54% to 67% and a decrease in the 2-year bladder invasive disease relapse rate from 32% to 18%. The 5-year overall survival rate increased from 35% to 48%, without a significant increase in adverse effects. Importantly, patients in the chemoradiotherapy group were less likely to require salvage cystectomy than those receiving radiotherapy alone. The results of this study suggest that chemoradiotherapy may be an effective alternative to surgery in the treatment of muscle-invasive bladder cancer. Additional studies that directly compare chemoradiotherapy with surgery or identify biomarkers predictive of a radiotherapy response will continue to improve the treatment options for patients who wish to pursue an organ-preserving alternative.