Fewer, but larger doses of radiation, reduce the risk of bladder cancer returning, according to a study published today.
The study, published today in The Lancet Oncology, concludes that the new methodology could result in patients needing 12 fewer trips to hospital, without reducing the quality and impact of their bladder cancer treatment.
The research, by scientists at the University of Manchester and The Institute of Cancer Research, London, is the first to compare directly the two radiotherapy schedules used to treat muscle-invasive bladder cancer.
They found patients who received a 20-dose radiotherapy course delivered over four weeks had a 29% lower risk of their cancer returning, over the five years following treatment, than those receiving a 32-dose course delivered over six and a half weeks.
The reduced risk of disease returning was observed in patients who received a combination of radiotherapy and chemotherapy, and in those who had radiotherapy alone.
Patients on the shorter course received a total of 55 Gy of radiation, compared with 64 Gy on the longer one.
The study found no increased risk of side effects with the shorter course, and no significant difference in quality of life and overall survival between patients receiving the two radiotherapy schedules.
They say the shorter course produces a similar outcome while using fewer resources – and that minimising hospital visits for cancer patients reduces their risk of exposure to Covid-19, is more convenient for patients and also reduces demand on the NHS.
Study co-leader Dr Nuria Porta, principal statistician at The Institute of Cancer Research, London, said: “This study presented a unique opportunity to use data from two large randomised clinical trials to make comparisons between the two different radiotherapy schedules used to treat muscle invasive bladder cancer in the UK.
“Using robust statistical methods, we showed that the shorter course of radiotherapy was at least as good for patients overall and reduced the likelihood of a person’s cancer coming back after treatment.”
Joint study leader Professor Ananya Choudhury, consultant in clinical oncology at The Christie and The University of Manchester, added: “These are very exciting results and we have made significant progress in understanding how radiotherapy can help bladder cancer patients. We know bladder cancer can advance rapidly, so giving a higher dose over a shorter time can really benefit the patient.
“Around 10,200 people are diagnosed with bladder cancer in the UK every year. We hope these findings will lead to a new standard of care which will increase survival rates and extend the lives of many thousands of people in the future.”
Joint study leader Professor Robert Huddart, professor of urological cancer at The Institute of Cancer Research, London, and Consultant in Urological Oncology at The Royal Marsden NHS Foundation Trust, said: “We are strongly advocating the widespread use of the shorter course of radiotherapy for bladder cancer and believe it should be adopted as the new standard of care for patients with the disease.”
Lancet Oncology 2 February 2021
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