Radiotherapy as effective as surgery in bladder cancer treatment

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

Bladder cancer the fifth most common cancer in the UK, with 10,093 new cases diagnosed in 2004. It accounts for one in every 27 new cases of cancer each year in the UK.

The majority of bladder cancer cases in the UK are transitional cell cancers, where the cells of the bladder lining are affected. The cancer may be superficial or invasive. Superficial cancers affect only the lining of the bladder, while invasive cancers have grown into the muscle layer of the bladder, or further.

Treatment for invasive cancer can include radical cystectomy - surgery involving the complete removal of the bladder. The bladder is either replaced by a bag or pouch made from bowel tissue to collect urine or the bladder is reconstructed in complex surgery.

For more information on bladder cancer visit our patient information website CancerHelp UK.

About the University of Leeds

The Leeds Institute of Molecular Medicine (LIMM) is a newly-created Institute in the Faculty of Medicine at the University of Leeds. It is located in sites at St James's University Hospital, Chapel Allerton Hospital and on the University's central Leeds campus. LIMM is dedicated to research into defining the molecules involved in human diseases and in translational research to convert these studies into novel therapies and new drugs. Find out more on the Institute's homepage.

About Cancer Research UK

• Together with its partners and supporters, Cancer Research UK's vision is to beat cancer.
• Cancer Research UK carries out world-class research to improve understanding of the disease and find out how to prevent, diagnose and treat different kinds of cancer.
• Cancer Research UK ensures that its findings are used to improve the lives of all cancer patients.
• Cancer Research UK helps people to understand cancer, the progress that is being made and the choices each person can make.
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