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This Week in NEJM: Apr 19, 2012


In NEJM this week, researchers in the UK report on the efficacy of radiotherapy for the treatment of muscle-invasive bladder cancer. The team randomly assigned 360 bladder cancer patients to undergo radiotherapy with or without synchronous chemotherapy. The two-year locoregional disease-free survival rate for the combination radiotherapy/chemotherapy group was 67 percent compared to 54 percent for the radiotherapy alone group, the team found. Further, at five years, the overall survival rates were 48 percent for the combination group and 35 percent for the radiotherapy group. "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," the authors write.

In a related editorial appearing in NEJM this week, Harvard Medical School's William Shipley and Anthony Zietman write that bladder cancer is "turning a corner" as more treatments are being devised for the disease. In particular, studies like that described above show that although bladder cancer is not as well researched as prostate or breast cancer, more sophisticated treatments can be developed, and combination therapies could benefit patients. In addition, there are studies being done on the molecular basis of bladder cancer that could inform which treatments each patient is likely to respond to. "The development of organ-sparing procedures in breast and prostate cancer was promoted by vocal patient advocacy groups with the use of the Internet and social networking," Shipley and Zietman write. "We anticipate that the publication of this important study will help patients with bladder cancer to find their voice. Cystectomy will always remain part of an organ-sparing approach, but this trial shows that as primary treatment, it can now be regarded as one of several options for the patient."

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