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Postoperative Chemotherapy Plus Radiotherapy for Locally Advanced Bladder Cancer

By: Melissa S. Eng, MS
Posted: Monday, March 11, 2019

The addition of chemotherapy to radiotherapy after radical cystectomy may improve disease-free and overall survival in patients with locally advanced bladder cancer. Although the three therapies have independently shown a potential benefit in this patient population, this study suggests that together they can be effective “to address both local and distant disease.” Mohamed S. Zaghloul, MD, MSc, MB.BCh, of the Children’s Cancer Hospital Egypt, and colleagues presented their findings at the 2019 Genitourinary Cancers Symposium in San Francisco (Abstract 351).

In this phase III, single-center study, 153 patients with locally advanced bladder cancer were randomly assigned to receive either gemcitabine and cisplatin plus radiotherapy or radiotherapy alone. Eligible patients had at least one of the following: seminal vesicle invasion (≥ pT3b), grade 3 disease, and positive nodes; eligible patients also could have negative margins after radical cystectomy plus pelvic node dissection.

The median follow-up for chemotherapy plus radiotherapy was 21 months and 15 months for radiotherapy alone. Local failure occurred in two patients in the radiotherapy-alone group, and no local failures occurred in the combination-therapy group. The 2-year disease-free survival rate was 62% versus 48%, respectively (P = .031), and the 2-year overall survival rate was 71% versus 51% (P = .048). On a multivariable analysis, combination therapy was a significant predictor of improved disease-free (P = .016) and overall survival (= .039).

Late gastrointestinal toxicities of grade 3 or higher were seen in 7% of patients who received combination therapy and 8% of those who received radiotherapy alone.

Disclosure: The study authors’ disclosure information may be found at coi.asco.org.



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