Radio-chemotherapy for bladder cancer: Contribution of chemotherapy on local control

Area of Science:

• Oncology
• Radiation Oncology
• Medical Oncology

Background:

• Muscle invasive bladder carcinoma presents a significant treatment challenge.
• Radiotherapy (RT) alone has limitations in achieving optimal local control.
• Combined radio-chemotherapy (RCT) is an established treatment modality.

Purpose of the Study:

• To quantify the contribution of chemotherapy (CT) to local control in muscle invasive bladder carcinoma when combined with radiotherapy (RCT).
• To compare local control rates achieved with RCT versus RT alone.
• To analyze response rates based on different RCT treatment phases.

Main Methods:

• Systematic review of studies published after 1990 involving radiotherapy (RT) and combined radio-chemotherapy (RCT).
• Inclusion of studies with neo-adjuvant, concurrent, adjuvant, or combination CT regimens.
• Statistical comparison of complete response (CR) rates between RCT and RT-alone groups using the Wilcoxon rank-sum test.

Main Results:

• Mean complete response (CR) rates were significantly higher in RCT studies (75.9%) compared to RT-alone studies (64.4%) (P = 0.001).
• One-phase RCT (79.6% CR) showed higher response rates than two-phase RCT (71.6% CR) (P = 0.015).
• Current achievable tumor control rates with acceptable side effects appear to plateau around 70%.

Conclusions:

• Combined radio-chemotherapy (RCT) offers a significant improvement in local control for muscle invasive bladder carcinoma over radiotherapy (RT) alone.
• The current treatment strategies may be approaching a plateau in efficacy.
• Future advancements necessitate novel chemotherapeutic agents, targeted therapies, or modified fractionation to further enhance complete response rates.