Nav: Home

Combined modality treatment could be first course for muscle-invasive bladder cancer

May 31, 2017

ARLINGTON, Va., May 31, 2017 - A meta-analysis of previously published cancer research showed no difference in five-year and 10-year survival rates between patients who underwent radical cystectomy, which is the surgical removal of the bladder, and a bladder-preserving combined modality treatment (CMT) plan, which combines radiation therapy, chemotherapy and the removal of the bladder tumor. The study is published in the International Journal of Radiation Oncology * Biology * Physics, the flagship journal of the American Society for Radiation Oncology.

With muscle-invasive bladder cancer (MIBC), when the cancer has invaded the muscle layer of the bladder wall, radical cystectomy (RC) is currently the standard course of treatment, with CMT reserved as a secondary option for patients not healthy enough for RC. There are drawbacks to undergoing a radical cystectomy, however--namely that additional surgery is needed after removal of the bladder to reconstruct a way to store urine, either inside or outside of the body.

Combined modality treatment--consisting of radiation therapy, concurrent chemotherapy and maximal transurethral resection of the bladder tumor-- provides an alternative to complete bladder removal for patients with MIBC. This approach could potentially be considered as a first course of treatment for many patients, say the study's authors--not just for those patients with significant comorbidities.

"These results provide compelling evidence suggesting radiation therapy may be as good as surgery for many of these patients," said Dharam Kaushik, MD, senior author of the study and an assistant professor at The University of Texas Health Science Center, now called UT Health San Antonio, and the UT Health Cancer Center. "We hope this study will help patients and their physicians understand the full range of options available when planning treatment for muscle-invasive bladder cancer."

Researchers comprehensively reviewed 19 published studies encompassing 12,380 patients, of which eight prospective and retrospective studies encompassing 9,554 patients were eligible for the meta-analysis. Eligible studies directly compared one or more survival outcome between the two treatment approaches (i.e., radical cystectomy or combined therapy including radiation). Researchers computed hazard ratios (HR) to compare survival outcomes including overall survival (OS), disease-specific survival (DSS) and progression-free survival (PFS) at five and 10 years' post-treatment.

The researchers found no difference in OS at five years' post-treatment (HR, 0.96, favoring CMT; p = 0.778; four studies, 452 patients) or 10 years (HR, 1.02, favoring RC; p = 0.905; five studies, 9,295 patients). They also found no difference in DSS at five years (HR, 0.83, favoring CMT; p = 0.390; two studies, 326 patients) or 10 years (HR, 1.17, favoring RC; p = 0.264; four studies, 9,171 patients). At 10 years, post-treatment, they found no difference in PFS (HR, 0.85, favoring CMT; p = 0.639; two studies, 293 patients). There were no studies that examined PFS at five years' post-treatment.

"According to our analyses, patients undergoing radical cystectomy likely share no cancer survival benefits compared with patients receiving chemoradiation-based bladder preservation therapy," said Dr. Kaushik.

These findings--that a less-invasive treatment option may be sufficient--are encouraging for those with MIBC. And while the researchers say that bladder-preserving treatment, such as CMT, may be an option for more patients, they say it also highlights the need for more studies specifically comparing the two modalities.

"Further research is needed to evaluate these two treatment arms--radical cystectomy versus combined modality treatment--to identify optimal treatments for specific patients," said Dr. Kaushik.

Based on the results published in the journal article, Dr. Kaushik and his team have launched a pilot clinical research study of 30 patients with MIBC. Half will be treated with RC and half will be treated with CMT, including radiation therapy. The trial is currently enrolling patients.
For more information or a copy of the full study, contract ASTRO's media relations team. For the study abstract, visit For more information about the Red Journal, visit

Resources available on bladder cancer:
  • Digital brochures: Radiation Therapy for Bladder Cancer, Radiation Therapy for Cancer
  • Videos: An Introduction to Radiation Therapy
  • Web: More resources available on RT Answers, ASTRO's patient education site.
  • Clinical guideline: Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline


ASTRO is the premier radiation oncology society in the world, with more than 11,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology  Biology  Physics and Practical Radiation Oncology and Advances in Radiation Oncology; developed and maintains an extensive patient website,; and created the Radiation Oncology Institute, a non-profit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit

American Society for Radiation Oncology

Related Cancer Articles:

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
More Cancer News and Cancer Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...