Radiotherapy as effective as surgery in bladder cancer treatment

Radiotherapy is as effective as surgery in treating bladder cancer, according to a study.

The study by Cancer Research UK scientists has found that survival rates among bladder cancer patients treated with radiotherapy in Leeds are the same as those associated with radical cystectomy – surgery involving the complete removal of the bladder.

The finding suggests that radiotherapy could be preferred over surgery, particularly in elderly patients, because of the potentially severe impact on quality of life that removing the bladder can have.

The researchers, led by Dr Anne Kiltie based at the Cancer Research UK Clinical Centre, part of the Leeds Institute of Molecular Medicine at the University of Leeds, analysed the medical records of 169 patients treated for invasive bladder cancer between 1996 and 2000. 97 of the patients had been treated with radiotherapy, while 89 had undergone surgery.

The survival rates for the two treatment groups, in terms of deaths from bladder cancer, were then compared five years and eight years after treatment, with no significant differences at either time interval found.

The five-year survival rate for radiotherapy patients was 56.8 per cent, compared with 53.4 per cent of surgery-treated patients. At eight years, survival rates were 54.9 per cent and 53.4 per cent respectively.

This was despite the radiotherapy group being older, with an average age of 75.3 years compared with an average of 68.2 years for the surgery group.

There was also no difference in how likely the disease was to return in the two treatment groups, with 34 per cent of the radiotherapy treatment group experiencing recurrence, compared with 37.5 per cent of those treated with surgery.

Dr Anne Kiltie, lead author of the paper, said: “Until now surgery has been considered better than radiotherapy in the treatment of bladder cancer that has spread to the muscle wall of the bladder.

“Although radiotherapy carries its own long term side effects, the interesting finding in our study was that the older, less fit patients did as well as the younger, fitter patients who had surgery to treat their cancer.

“Since bladder cancer is a disease of older people, radiotherapy will play an increasingly important role as the population ages, and this study encourages us to believe that such elderly patients will not be disadvantaged by having an alternative curative treatment to surgery for their bladder cancer.”

Currently, cystectomy surgery is regarded as the ‘gold standard’ treatment for muscle-invasive bladder cancer in the UK – most common in elderly patients. Doctors typically opt to remove the whole bladder along with the prostate in men and, in some cases, the womb and ovaries in women.

However, this may result in continence problems, the use of a catheter, as well as the possibility of infections or other post-surgery complications.

Dr Lesley Walker, Cancer Research UK’s director of cancer information, said: “Evaluating the various treatment options available is important in providing the most effective and appropriate care for cancer patients.

“This study certainly opens the debate on which treatments should be recommended for invasive bladder cancer patients, although the research is retrospective and the cohort of patients is small, so further investigations are necessary to establish if radiotherapy should replace surgery as the ‘gold standard’ treatment for these patients.”

(Source: University of Leeds: February 2008)