Combination Cancer Therapy Salvages Bladder

By Fackelmann, Kathy A. | Science News, November 6, 1993 | Go to article overview

Combination Cancer Therapy Salvages Bladder


Fackelmann, Kathy A., Science News


An experimental approach to invasive bladder cancer may spare the bladder yet save the patient.

For the past 20 years, surgeons have treated such malignancies by removing the entire bladder. Although that traditional approach results in a 50 percent survival rate after five years, patients must live with the discomfort of urine-collecting bags that never quite work the way a healthy bladder does.

Oncologist Donald S. Kaufman and his colleagues at the Massachusetts General Hospital in Boston didn't want to jeopardize their patients' survival, but they did want to avoid radical surgery if possible. So they devised a regimen designed to preserve the bladder while launching a blitz on the cancer.

This year, an estimated 52,300 people in the United States will develop bladder cancer. About 30 percent of that group would be candidates for the experimental regimen, Kaufman estimates.

The Boston team recruited 53 people with invasive bladder cancer, in which the disease has spread to the bladder's muscular wall. All 53 then underwent a procedure called transurethral resection, in which surgeons guide a slender fiberoptic scope through the urethra to the bladder. Aided by a video display of the bladder's interior, surgeons then manipulate tiny instruments to remove the tumor. Afterwards, patients received an initial blast of several different types of chemotherapeutic drugs, as well as radiation therapy.

For patients who showed any signs that their cancers had not responded, the team recommended complete removal of the bladder, the traditional operation known as radical cystectomy. Rather than risk a recurrence of cancer, eight patients opted for this operation.

In 34 cases, patients either responded well to early therapy or couldn't tolerate such a drastic operation. They went on with the experimental treatment, which consisted of more chemotherapy and radiation, the researchers report in the Nov. 4 NEW ENGLAND JOURNAL OF MEDICINE. …

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