Researchers from Germany have reported that a strategy of transurethral resection followed by chemoradiotherapy with regional deep hyperthermia results in local recurrence-free survival of 85% in patients with high-risk Stage I and II bladder cancer. The details of this study were published early online in Radiotherapy and Oncology on October 19, 2009.[1] 

Patients with superficial bladder cancer (Stage I) are usually treated with local therapy followed by cystectomy when local therapy is not effective. Patients with Stage II muscle-invasive disease are often treated initially with cystectomy. However, recent studies have suggested that radiation therapy and/or chemotherapy can spare patients cystectomy. There have also been recent studies suggesting that hyperthermia can improve the effects of chemotherapy for bladder cancer.

The current study included 45 patients with high-risk Stage I and II bladder cancer. All patients received radiotherapy to the bladder and regional lymph nodes as well as concurrent chemotherapy. Regional deep hyperthermia was administered once weekly. The complete response rate was 92%, local recurrence-free survival was 85%, overall survival was 80%, disease-specific survival was 88%, and bladder preservation rate was 96%. Bladder function was deemed satisfactory in 80% of patients.

Comments: These data suggest that multimodality therapy can obviate the need for cystectomy in many patients with high-risk bladder cancer. The relative contribution of each component of therapy is unclear and would require randomized trials to clarify. However, toxicities associated with this multimodality approach were not prohibitive.

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