(HealthDay is the new name for HealthScoutNews.)
WEDNESDAY, Aug. 27, 2003 (HealthDayNews) -- People with bladder cancer who had chemotherapy before surgery had vastly improved survival rates, compared to those who only had surgery.
The difference in survival rates between the two groups was 31 months, says a study in the Aug. 28 issue of the New England Journal of Medicine.
Bladder cancer is the fourth most common cancer in American men and the eighth in women. Even with aggressive treatment, this cancer tends to spread and physicians have been searching for ways to better attack the disease.
"The controversy has centered on chemo before or chemo only after surgery if the patient recurs," says Dr. Robert G. Uzzo, a surgical oncologist at Fox Chase Cancer Center in Philadelphia.
"There have been a number of attempts to do this sort of study in the past and all have been very, very difficult to interpret for a number of reasons. For the first time in a controlled, very didactic fashion the authors here control most of the variables and do it prospectively and most of the patients that they intend to treat get treated. That's why this is a significant study."
While some medical centers do administer chemotherapy before surgery, other do not.
"Some people think it works and some don't. This is really the first study to show that it provides benefit," says study investigator Dr. H. Barton Grossman, a professor of urology at the University of Texas M.D. Anderson Cancer Center in Houston.
The 11-year study involved 307 patients at 126 institutions across the United States. All the participants had cancer that had reached the muscle of the bladder and were scheduled to undergo a radical cystectomy -- removal of the bladder. The patients were divided into two groups: 154 who had surgery and 153 who also had surgery, but only after three cycles of a chemotherapy regimen known as M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin).
Those who received chemotherapy lived an average of 77 months, and some are still living 10 years after treatment. Those who only had surgery lived an average of 46 months.
Are these findings likely to change standard practice?
"I would hope that for people who are a high risk that this will be a treatment approach that will be increasingly used," Grossman says.
M-VAC is increasingly being replaced by chemotherapy combinations using fewer drugs with fewer side effects, Uzzo adds. Grossman believes this should brighten the survival picture even more.
"With better chemo, you'd hope that results would improve and the logical extension is, if you eventually come up with good enough chemo, then maybe you don't have to remove the bladder at all," Grossman says. "That would obviously be a long-term goal but I don't think we're too close to that at this point."
The best candidates for the combined chemotherapy and surgery regimen are those whose cancer has spread to the bladder muscle, although you can't discount the therapy for those who are going to have their bladder removed.
"The question comes down to is the toxicity of the chemo worth it," Grossman says. "That makes it a somewhat more difficult choice. But if you want to maximize the chances of being cured, the data suggests that for muscle-invasive cancer, combination therapy is better than surgery alone."
More information
For more on bladder cancer, visit the National Cancer Institute or the National Library of Medicine.
