July 9, 2002 For patients with the most serious form of bladder cancer, the standard of care has been to completely remove the bladder and adjacent organs. Now scientists at Massachusetts General Hospital (MGH) have shown that therapeutic strategies aimed at sparing the bladder have long-term cure rates just as good as does bladder removal. The findings, which appear in the July issue of Urology, could offer a better quality of life for many patients.
"Saving the bladder is a big event," says co-author William Shipley, MD, deputy head for clinical research of the MGH Department of Radiation Oncology. "Our first goal is to save the patient's life, but our second goal is to preserve the bladder if safely possible."
One-third of all bladder cancers are of the most serious invasive form, in which the tumor penetrates the organ's muscular layers. Shipley and his colleagues used a three-pronged or "tri-modality" approach in their attempt to combat this often deadly condition. Members of the MGH research team had developed this approach and reported a pilot study's results in 1993.
One hundred ninety patients were treated in this study. First, surgery was performed to remove the patient's tumor from the bladder. Then, radiation and chemotherapy treatments were administered; chemotherapy complements the cancer-killing effects of radiation, which is directed at the bladder itself. One-third of patients enrolled in the study did eventually require bladder removal, because tests conducted several weeks after administering the tri-modality approach showed that some cancer remained. However, the ten-year survival rate for all patients in the study was as good as that of radical bladder removal, which has been the standard of care for invasive tumors.
The researchers note that current treatments for bladder cancer are effective in reducing recurrence of cancer in the pelvic area, but 50 percent of all invasive bladder cancer patients will eventually die from cancer that had spread or metastasized from its original location at the time of original diagnosis. "That's why we include adjuvant chemotherapy, as is used for patients with breast cancer and other high-risk cancers, to try and reach cancer cells throughout the body," says co-author Donald S. Kaufman, MD, medical oncologist and director of the MGH Genitourinary Cancer Program. "We are identifying newer and better drugs that are both more effective and less toxic to the patient"
Shipley adds that the new treatment strategy is gaining acceptance "As an alternative to radical surgery, it's now being offered to more patients, although it's not yet as common as are lumpectomies for breast cancer."
The other members of the MGH research team are Elizabeth Zehr, Naill Heney, MD, Steven Lane, MD, H.K. Thakral, Alex Althausen, MD, and Anthony Zietman, MD.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $300 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Women's Hospital to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.
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