A new study suggests a three-pronged treatment approach that utilizes image-guided, intensity-modulated radiation therapy (IG-IMRT) for localized bladder cancer may yield good bladder preservation outcomes. The research, published in the International Journal of Radiation Oncology, indicated that the bladder preservation rate was 83 percent at three years.

“These findings will lend credence to the clinical utility of advanced technology and help in establishing IG-IMRT as a standard method of bladder preservation in suitable patients,” Dr. Vedang Murthy, lead author of the study and radiation oncologist at Tata Memorial Centre in Mumbai, India, told HCB News via e-mail. “More centres will be encouraged to adopt it worldwide as now there is proof of its safety and efficacy.”

The current standard treatment for advanced-stage bladder cancer is a cystectomy, which involves removing the bladder. The new trimodality approach consists of transurethral resection of the bladder tumor, IG-IMRT and chemotherapy.

“For early muscle-invasive disease (stage 2 and some stage 3 cancers) bladder preservation with radiation and concurrent chemotherapy is equally effective as surgery with the added advantage of preserving the patient’s native bladder in about 70 percent of the cases,” said Murthy.

The researchers evaluated 44 patients between August 2008 and August 2014 — 39 were male and five were female, ranging from 55 to 72 years old, and 88 percent of them had stage 2 bladder cancer. The patients underwent procedures to resect the tumor and concurrent platinum-based chemotherapy, and those with large tumors were offered induction chemotherapy.

Six to 10 weeks after treatment, all of the patients had a complete response. The study had a median follow-up of 30 months and the overall survival rate at the last follow up was 77 percent — three of the patients died from comorbidities and were disease-free at the time of death.

Murthy believes that IG-IMRT will eventually become part of the standard of care for treating bladder cancer because bladder is an ideal organ for image-guided radiotherapy.

“Traditionally, bladder radiotherapy has had inherent problems with bladder motion needing large margins to treat effectively, which in turn caused side effects,” said Murthy. “IG-IMRT can clearly deliver radiation more accurately and safely. As the technology is already widely available, there is no reason not to use it in some form in clinical practice.”

However, more research is needed with larger groups of patients in order to establish the approach as the standard. The results of this study provide a proof-of-concept of using IGRT in the clinic, and Murthy hopes that it will lead to more suitable patients undergoing bladder preservation around the world.

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