Bladder Cancer Recurrence Risk Reduced with Chemotherapy After Cancer
Dr. Richard J. Sylvester, from the European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium, and colleagues reported that the recurrence risk of superficial bladder cancer is reduced by immediate instillation of chemotherapy post-cancer resection. However, the research team cautioned the use of chemotherapy in patients with high recurrence risk as there is limited study data supporting it.
The research team based their study on 11 out of 13 other relevant randomized controlled studies. Their study includes 2278 patients with low-grade tumors who received a combination of chemotherapy post-cancer resection or transurethral bladder resection alone. Chemotherapy used in this study includes thiotepa, pirarubicin, mitomycin C, or epirubicin. Overall, there were 460 deaths. 59 out of the 460 deaths were attributed to bladder cancer. 108 patients had progressions and 1,128 had recurrences. Usage of chemotherapy after surgery reduced the recurrence risk by 35%. The absolute reduction in recurrence at 5 years was reduced from 58.8% to 44.8% which is 14%. However, their study data revealed that the recurrence rate of bladder cancer in greater risk patients were not reduced. This subgroup of high-risk patients was mainly those with 5 or greater EORTC recurrence score and those who had one or more recurrence per year prior to this study.
The research team commented that the aim of their study was to dissolve controversies regarding the use of chemotherapy post-cancer resection as physicians were doubtful of The European Association of Urology guidelines recommending that all intermediate and low-risk patients receive immediate chemotherapy post-cancer resection. J. Alfred Witjes, from Radboud University Nijmegen Medical Center, the Netherlands, hoped that this study will encourage urologists to use chemotherapy post-resection in patients with low-risk bladder cancer as this method ensures good patient outcomes and quality of care as well as lowering health care costs. He added that all the chemotherapeutic drugs used in this study showed the same efficacy except for thiotepa.