Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer
Nicholas D James, Syed A Hussain, Emma Hall, Peter Jenkins, Jean Tremlett, Christine Rawlings, Malcolm Crundwell, Bruce Sizer, Thiagarajan Sreenivasan, Carey Hendron, Rebecca Lewis, Rachel Waters, Robert A Huddart, BC2001 Investigators, R Huddart, B Sizer, N James, T Sreenivasan, D Bloomfield, A Lydon, J Wallace, F Adab, P Crellin, H Newman, D Sheehan, I Syndikus, S Gibbs, A Stockdale, C Elwell, J Graham, F Neave, A Samanci, S Beesley, P Hoskin, A Cook, M Russell, J Glaholm, P Jenkins, S Mangar, N Srihari, R Srinivasan, A Bahl, A Birtle, M Carr, C Humber, D Landau, T Roberts, D Stewart, J Bowen, J Harney, F McKinna, M Panades, R Subramanian, H Taylor, P Wells, P Wilson, N Anyameme, R Beard, P Chakraborti, M Churn, J Davies, R Eakin, C Eswar, T Hickish, N Hodson, P Leone, J Littler, J O'Sullivan, L Reinecke, A Robinson, C Rowland, H Van der Voet, A Zarkar, Nicholas D James, Syed A Hussain, Emma Hall, Peter Jenkins, Jean Tremlett, Christine Rawlings, Malcolm Crundwell, Bruce Sizer, Thiagarajan Sreenivasan, Carey Hendron, Rebecca Lewis, Rachel Waters, Robert A Huddart, BC2001 Investigators, R Huddart, B Sizer, N James, T Sreenivasan, D Bloomfield, A Lydon, J Wallace, F Adab, P Crellin, H Newman, D Sheehan, I Syndikus, S Gibbs, A Stockdale, C Elwell, J Graham, F Neave, A Samanci, S Beesley, P Hoskin, A Cook, M Russell, J Glaholm, P Jenkins, S Mangar, N Srihari, R Srinivasan, A Bahl, A Birtle, M Carr, C Humber, D Landau, T Roberts, D Stewart, J Bowen, J Harney, F McKinna, M Panades, R Subramanian, H Taylor, P Wells, P Wilson, N Anyameme, R Beard, P Chakraborti, M Churn, J Davies, R Eakin, C Eswar, T Hickish, N Hodson, P Leone, J Littler, J O'Sullivan, L Reinecke, A Robinson, C Rowland, H Van der Voet, A Zarkar
Abstract
Background: Radiotherapy is an alternative to cystectomy in patients with muscle-invasive bladder cancer. In other disease sites, synchronous chemoradiotherapy has been associated with increased local control and improved survival, as compared with radiotherapy alone.
Methods: In this multicenter, phase 3 trial, we randomly assigned 360 patients with muscle-invasive bladder cancer to undergo radiotherapy with or without synchronous chemotherapy. The regimen consisted of fluorouracil (500 mg per square meter of body-surface area per day) during fractions 1 to 5 and 16 to 20 of radiotherapy and mitomycin C (12 mg per square meter) on day 1. Patients were also randomly assigned to undergo either whole-bladder radiotherapy or modified-volume radiotherapy (in which the volume of bladder receiving full-dose radiotherapy was reduced) in a partial 2-by-2 factorial design (results not reported here). The primary end point was survival free of locoregional disease. Secondary end points included overall survival and toxic effects.
Results: At 2 years, rates of locoregional disease-free survival were 67% (95% confidence interval [CI], 59 to 74) in the chemoradiotherapy group and 54% (95% CI, 46 to 62) in the radiotherapy group. With a median follow-up of 69.9 months, the hazard ratio in the chemoradiotherapy group was 0.68 (95% CI, 0.48 to 0.96; P=0.03). Five-year rates of overall survival were 48% (95% CI, 40 to 55) in the chemoradiotherapy group and 35% (95% CI, 28 to 43) in the radiotherapy group (hazard ratio, 0.82; 95% CI, 0.63 to 1.09; P=0.16). Grade 3 or 4 adverse events were slightly more common in the chemoradiotherapy group than in the radiotherapy group during treatment (36.0% vs. 27.5%, P=0.07) but not during follow-up (8.3% vs. 15.7%, P=0.07).
Conclusions: Synchronous chemotherapy with fluorouracil and mitomycin C combined with radiotherapy significantly improved locoregional control of bladder cancer, as compared with radiotherapy alone, with no significant increase in adverse events. (Funded by Cancer Research U.K.; BC2001 Current Controlled Trials number, ISRCTN68324339.).
Source: PubMed