Weekly radiotherapy suitable for bladder cancer patients too frail for aggressive treatment, study finds

An intensity-modulated radiation therapy machine (photo: Jan Chlebik/the ICR) 

Older patients with bladder cancer who are too frail for aggressive treatment could benefit from weekly image-guided radiotherapy, new research reports.

A team at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust looked specifically at older patients with bladder cancer, and found that image-guided radiotherapy given in weekly doses was suitable for those unable to cope with other treatments.

In 55 elderly patients with bladder cancer, a weekly schedule of radiotherapy was well tolerated, with 87% of patients completing the treatment, and controlled symptoms of their disease for as long as two years.

The study, published in the International Journal of Radiation Oncology, Biology, Physics, was funded by Cancer Research UK, with additional support from the National Institute for Health Research Biomedical Research Centre at the ICR and The Royal Marsden.

A different approach

The research looked at patients with muscle-invasive bladder cancer – a serious form of bladder cancer that has spread into the muscle layer of the bladder which can be found in older people.

Normally the disease is treated through surgery or daily doses of radiotherapy, but elderly patients may not receive treatment because they are deemed too frail to cope with these aggressive strategies.

Researchers at the ICR and The Royal Marsden studied 55 bladder cancer patients with an average age 86, to see if weekly doses of image-guided radiotherapy could be an acceptable way to treat their disease.

The researchers took CT scans of patients’ bladders to determine the best plan for radiotherapy on the day of treatment, so that larger, more accurate doses of radiation could be given over a longer period of time compared with other radiotherapy plans.

Well tolerated

They found that the majority of patients completed the six-week treatment schedule and could tolerate the weekly doses of radiotherapy with manageable side-effects.

Some 36 patients were followed up three months later for their response to radiotherapy, and the researchers found that the disease had been controlled in 92% of those assessed.

Of the patients treated in the trial, 63% survived one year after radiotherapy, and 27% were still disease free two years on.

Professor Robert Huddart, Professor of Urological Cancer at the ICR and Honorary Consultant in Urological Oncology at The Royal Marsden said: “Bladder cancer is relatively common and elderly patients make up a significant portion of people with the disease, but the oldest and most frail patients may not receive any treatment beyond palliative care. Our study shows that weekly doses of image-guided radiotherapy could provide accurate treatment to control their disease.

“We found that weekly image-guided radiotherapy could improve patients’ quality of life by preventing the symptoms of the disease, without too many side-effects. Although elderly patients may be in the final years of their life, sometimes the best palliative care is by eradicating their cancer.”